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Canadian Journal of Cardiology

Infective Endocarditis Hospitalizations Before and After the 2007 American Heart Association Prophylaxis Guidelines

Published:October 07, 2015DOI:https://doi.org/10.1016/j.cjca.2015.09.021

      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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