Trends in Epidemiology, Clinical Characteristics, and Outcomes of Infective Endocarditis: A 16-Year Nationwide Cohort Study in Korea

Abstract

Background: Infective endocarditis (IE) is a life-threatening disease, the profile of which varies across countries. This nationwide cohort study aimed to assess the epidemiology, clinical characteristics, and outcomes of IE. Methods: Patients diagnosed with IE between 2003 and 2018 were included in this study based on data from the National Health Insurance System of South Korea. The patients' baseline characteristics, treatment modalities, and survival outcomes were analyzed. The incidence and in-hospital mortality rates were calculated and adjusted for age. Results: A total of 8,487 IE cases were included: 6,617 (78.0%), 1,678 (19.8%), and 192 (2.3%) cases of native valve IE, prosthetic valve IE, and cardiac device-related IE (CDRIE), respectively. The incidence rate (per 1,000,000) of IE increased from 7.24 in 2003 to 17.47 in 2018. Furthermore, the in-hospital mortality rate for IE (per 1,000,000 person-years) increased from 0.59 in 2003 to 2.76 in 2018. The proportions of prosthetic valve IE and CDRIE cases increased over time, whereas that of native valve IE cases decreased. The number of surgeries for IE showed a consistent upward trend, with a notable increase occurring from 2014 onward. Conclusion: IE is a health burden with an increasing incidence and high mortality rates. Understanding the epidemiology and characteristics of IE is crucial to establish future treatment strategies.