ArticleFrontiers in cardiovascular medicine2026
Avoidable delays in the care of infective endocarditis patients: a priority issue.
Article in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Guidelines recommend prompt diagnosis and timely surgical intervention for infective endocarditis (IE); however, adherence in clinical practice remains inconsistent. We quantified delays throughout the IE care pathway and evaluated their association with mortality after adjusting for baseline severity. Methods: We conducted a retrospective single-centre cohort study of consecutive patients with definite IE and a guideline-based surgical indication who were admitted to Misericordia Hospital, Grosseto (Italy), between 1 January 1998 and 31 December 2023. Time intervals from the first symptom to hospital admission, to transthoracic (TTE), transoesophageal (TOE) echocardiography, and surgery were recorded. Patients were classified as In-Time if surgery was performed within the guideline-recommended timeframe (emergency: <24 h; urgent: <5 days; elective: otherwise) or Delayed. A prespecified subgroup analysis within the Delayed group distinguished Delayed-operated from Delayed-never-operated patients. Univariable and multivariable logistic regression estimated the association between delay and in-hospital mortality, adjusting for age, Sequential Organ Failure Assessment (SOFA) score, Results: The analytic cohort comprised 198 patients with a surgical indication: 62 (31.3%) in the In-Time group and 136 (68.7%) in the Delayed group (78 Delayed-operated and 58 Delayed-never-operated). The interval from symptom onset to hospital admission was the largest single contributor to the total time to surgery (∼50% of the total). Crude in-hospital mortality was 9.7% in the In-Time group and 40.4% in the Delayed group ( Conclusions: Delays are common along the IE care pathway and concentrated in the pre-admission and indication-to-surgery phases. Patients with delayed management have substantially higher crude and adjusted in-hospital mortality, with the worst outcomes in patients who never reach the operating room. These observations support modifiable system-level priorities: educating general practitioners and high-risk patients about suspicious symptoms; faster in-hospital access to TOE and PET/CT; and implementing a structured endocarditis Heart Team with protected operating slots.
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