Clinical course and prognosis of infective endocarditis in the elderly

Introduction. In recent decades the mean age of patients with infective end ocarditis has progressively increased. The objective of the present study w as to describe the clinical features and prognoses of infective endocarditi s in the elderly. Methods. A prospective study was performed of 125 non drug abuser patients over the age of 14 years and admitted from 1987 until 1997 in a single inst itution. Twenty-one patients were older than 65 years. Results. No significant differences were observed among the age groups with respect to delay in diagnosis, clinical signs, site of the infection and t he rate of negative blood cultures. Prosthetic valve endocarditis was more frequent in elderly than in younger adults (41 and 33%, respectively). S. v iridans and enterococcus were more frequent (47 compared with 29% in younge r adults, p < 0.05). Elderly patients underwent surgery less frequently (46 versus 56%) and most surgery was performed on an emergency basis. The in h ospital mortality was higher in the elderly (50 versus 15%), p < 0.05. Conclusions. Prosthetic valve endocarditis and severe complications during the active phase are more frequent in the elderly and this is related to a worse prognosis in the short and intermediate term. A higher rate of electi ve surgery during the active phase could improve the prognosis of infective endocarditis in the elderly.