Background— The purpose of this statement is to update the recommendations by the American Heart Association (AHA) for the prevention of infective endocarditis that were last published in 1997. Met...

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Prevention of Infective Endocarditis Guidelines From the American Heart Association: A Guideline From the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group

Guidelines and Expert Consensus Documents summarize and evaluate all currently available evidence on a particular issue with the aim of assisting physicians in selecting the best management strategy for an individual patient suffering from a given condition, taking into account the impact on outcome, as well as the risk/benefit ratio of particular diagnostic or therapeutic means. Guidelines are no substitutes for textbooks. The legal implications of medical guidelines have been discussed previously.

A great number of Guidelines and Expert Consensus Documents have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organizations. Because of the impact on clinical practice, quality criteria for development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines and Expert Consensus Documents can be found on the ESC website (http://www.escardio.org/knowledge/guidelines/rules).

In brief, experts in the field are selected and undertake a comprehensive review of the published evidence for management and/or prevention of a given condition. A critical evaluation of diagnostic and therapeutic procedures is performed including assessment of the risk/ benefit ratio. Estimates of expected health outcomes for larger societies are included, where data exist. The level of evidence and the strength of recommendation of particular treatment options are weighed and graded according to predefined scales, as outlined in Tables 1 and 2 .

View this table:

Table 1 
Classes of recommendations



View this table:

Table 2 
Levels of evidence



The experts of the writing panels have provided disclosure statements of all relationships they may have which might be perceived as real or potential sources of conflicts of interest. These disclosure forms are kept on file at the European Heart House, headquarters of the ESC. Any changes in conflict of interest that arise during the writing period must be notified to …

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Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009)

Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009).

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Aims
To Assess changes in infective endocarditis (IE) epidemiology over the last 5 decades.

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Infective Endocarditis Epidemiology Over Five Decades: A Systematic Review

Infective endocarditis (IE) remains a dangerous condition with unchanging incidence and a mortality approaching 30% at 1 year.1,2 Surgery is potentially lifesaving3 and is required in 25% to 50% of cases during acute infection and 20% to 40% during convalescence.4–7 Operative procedures are often technically difficult and associated with high risk, not least because patients are frequently extremely sick with multisystem disease. Nevertheless, indications for surgery are clear in many patients, and international guidelines8,9 provide strong recommendations that are applicable for the majority. These guidelines are not supported by robust clinical evidence, however, and clinical decision making is often hampered by diverse considerations, including advancing age of the overall patient cohort, the presence of extracardiac complications or preexistent comorbidity, prior antibiotic therapy of varying duration, and the availability of appropriate surgical expertise. In this article, we review the evidence base that supports current clinical practice and attempt to provide recommendations in areas where doubt persists.

The role of surgery in active IE has expanded progressively since early reports of successful outcome.10 Subsequent declines in mortality may be attributed to a variety of improvements in management, although expeditious surgery in carefully selected patients has played a major role. Contemporary data in Europe indicate that surgery is now undertaken in approximately 50% of patients with IE; the most frequent indications are congestive heart failure (60%), refractory sepsis (40%), embolic complications (18%), and vegetation size (48%), with a combination of these factors being present in many patients.11

Overall surgical mortality in active IE is 6% to 25%, with long-term survival rates of approximately 70% in most series.4–7,12–31 Assessment of the impact of surgery on outcome is difficult, because the patients referred are frequently those with severe complications related to virulent organisms. Conversely, the most ill patients …

Surgery for Infective Endocarditis Who and When

Infective endocarditis--a prospective study at the end of the twentieth century: new predisposing conditions, new etiologic agents, and still a high mortality.

García Fernández Ma

Papers

Infective endocarditis--a prospective study at the end of the twentieth century: new predisposing conditions, new etiologic agents, and still a high mortality.