Abstract
Background
In 2007, the American Heart Association (AHA) published revised guidelines for infective
endocarditis (IE) prophylaxis. Population-based data with respect to the potential
impact of these revised guidelines are lacking.
Methods
The Canadian Institute for Health Information Discharge Abstract Database was used
to identify all hospitalizations between April 2002 and March 2013 having IE as a
primary diagnosis. Hospitalization rates were determined using age-specific population
data from Statistics Canada. Interrupted time series analysis was used to evaluate
changes in the slope of hospitalization rates after the AHA guidelines were published.
Results
There were 9431 hospitalizations during the study period among 8055 patients (63%
male patients). Time trend analysis showed an increase of 0.05 IE hospitalizations
per 10 million population per month (95% confidence interval, 0.005-0.09; P = 0.029) from April 2002-March 2007 and an increase of 0.07 IE hospitalizations per
10 million population per month from April 2007-March 2013 (interaction P = 0.5213). Change-point analysis showed that a change in the slope occurred in April
2011, 4 years after publication of the revised AHA guidelines. Staphylococcus aureus was the most commonly reported organism (29.4%). Streptococcal infections decreased
over time, beginning before the 2007 guidelines (P < 0.0001). The presence of a pacemaker or defibrillator was an increasingly prevalent
risk factor over time (4% increase per year; P = 0.0178).
Conclusions
The rate of IE hospitalizations increased in Canada before and after the publication
of the 2007 AHA guidelines, with no significant change in slope after 2007. These
guidelines had no impact on the incidence of IE hospitalizations.
Résumé
Introduction
En 2007, l’American Heart Association (AHA) a publié des lignes directrices révisées
sur la prophylaxie de l’endocardite infectieuse. Il existe peu de données issues de
la population quant aux répercussions possibles de ces lignes directrices révisées
depuis leur diffusion.
Méthodes
On a procédé au dépouillement de la base de données sur les congés des patients de
l’Institut canadien d’information sur la santé afin de déterminer le nombre d’hospitalisations
liées à un diagnostic primaire d’endocardite infectieuse survenues entre les mois
d’avril 2002 et de mars 2013. Les taux d’hospitalisation ont été calculés par groupe
d’âge à l’aide de données provenant de Statistique Canada. Une analyse de séries chronologiques
interrompues a ensuite été effectuée afin de déterminer, le cas échéant, la modification
de la courbe des hospitalisations à la suite de la publication des lignes directrices
révisées de l’AHA.
Résultats
Au cours de la période visée, on a recensé 9431 hospitalisations pour 8055 patients
(63 % des patients étaient de sexe masculin). L’analyse évolutive des tendances a
montré une augmentation de l’ordre de 0,05 hospitalisation liée à l’endocardite infectieuse
par 10 millions de personnes par mois (intervalle de confiance à 95 %, 0,005 à 0,09;
p = 0,029) entre avril 2002 et mars 2007 et une augmentation de l’ordre de 0,07 hospitalisation
liée à l’endocardite infectieuse par 10 millions de personnes par mois entre avril
2007 et mars 2013 (valeur p pour l’interaction = 0,5213). L’analyse de variation des points dans le temps a montré
qu’un changement dans la courbe des hospitalisations était survenu en avril 2011,
soit quatre ans après la publication des lignes directrices révisées de l’AHA. Le
staphylocoque doré était l’organisme en cause le plus souvent signalé (29,4 % des
cas). Les infections à streptocoques ont pour leur part diminué au fil du temps, une
baisse qui s’était amorcée avant même la publication des lignes directrices de 2007
(p < 0,0001). La présence d’un stimulateur cardiaque ou d’un défibrillateur cardiaque
constituait un facteur de risque augmentant la prévalence de la maladie au fil du
temps (augmentation de 4 % du risque par année; p = 0,0178).
Conclusion
Le taux d’hospitalisations liées à l’endocardite infectieuse s’est accru au Canada
avant et après la publication des lignes directrices révisées de l’AHA en 2007. Aucune
variation significative de la courbe des hospitalisations n’a été observée à la suite
de cette publication, ce qui indique que les lignes directrices révisées n’ont eu
aucune incidence sur la fréquence des hospitalisations liées à l’endocardite infectieuse.
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Article info
Publication history
Published online: October 07, 2015
Accepted:
September 23,
2015
Received:
July 14,
2015
Footnotes
See editorial by Morris and Webb, pages 933–934 of this issue.
See page 947 for disclosure information.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- The Effect of Antibiotic Prophylaxis Guidelines on Incidence of Infective EndocarditisCanadian Journal of CardiologyVol. 32Issue 12
- Reply to Letter From Thornhill et al.—Infective Endocarditis Hospitalizations Before and After the 2007 American Heart Association Prophylaxis GuidelinesCanadian Journal of CardiologyVol. 32Issue 12
