Original article
Adult cardiac
The Clinical Impact of Implementation of a Multidisciplinary Endocarditis Team

https://doi.org/10.1016/j.athoracsur.2021.02.027Get rights and content

Abstract

Background

Infectious endocarditis is associated with substantial in-hospital mortality of 15%-20%. Effective management requires coordination between multiple medical and surgical subspecialties, which can often lead to disjointed care. Previous European studies have identified multidisciplinary endocarditis teams as a tool for reducing endocarditis mortality.

Methods

The multidisciplinary endocarditis team was formed in May 2018. The group developed an evidence-based algorithm for management of endocarditis that was used to provide recommendations for hospitalized patients over a 1-year period. Mortality outcomes were then retroactively assessed and compared to a historical control utilizing propensity matching.

Results

Between June 2018 and June 2019 the team provided guideline-based recommendations on 56 patients with Duke Criteria–definite endocarditis and at least 1 American Heart Association indication for surgery. The historical control included 68 patients with definite endocarditis and surgical indications admitted between July 1, 2014, and June 30, 2015. In-hospital mortality decreased significantly from 29.4% in 2014-2015 to 7.1% in 2018-2019 (P < .0001). There was a non-significant increase in the rate of surgical intervention after implementation of the team (41.2% vs 55.4%; P = 0.12). Propensity score matching demonstrated similar results.

Conclusions

Implementation of a multidisciplinary endocarditis team was associated with a significant 1-year decrease in all-cause in-hospital mortality for patients with definite endocarditis and surgical indications, in the presence of notable differences between the 2 studied cohorts. In conjunction with previous studies demonstrating their effectiveness, these data support the idea that widespread adoption of endocarditis teams in North America could improve outcomes for this patient population.

Section snippets

Team Protocol

The University of Michigan Multidisciplinary Endocarditis Team (MDET) was formed on May 3, 2018. Core group members participate on a voluntary basis. The MDET met weekly and developed an evidence-based institutional protocol for diagnosis as well as surgical and medical management of IE (Supplemental Figure).11, 12, 13 The algorithm was designed for use by both general practitioners and subspecialists and was approved by the Departments of Cardiac Surgery and Neurology as well as the Divisions

Study Population

Between June 14, 2018, and June 13, 2019, the MDET presented and provided recommendations for 119 inpatients with IE. Fifty-six of these patients had definite endocarditis with at least 1 AHA surgical indication. The remaining 63 cases were excluded from further analysis (Figure 1).

The characteristics of the patients in both cohorts are provided in Table 1. The mean age of patients managed by the MDET was 50.7 years and 62.5% were male. The average patient in the historical control was

Comment

Our retrospective study demonstrated a significant improvement in the rate of in-hospital mortality for patients with definite endocarditis and indications for surgical intervention after implementation of a multidisciplinary endocarditis team. Mortality for medically managed patients also improved significantly. There was a nonsignificant increase in the proportion of patients undergoing surgical valve replacement after implementation of MDET. The post-MDET period also demonstrated a dramatic

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