The endocarditis team: a review

Introduction

Infective endocarditis (IE) is a complex infection of the endocardium, associated with significant morbidity and mortality. Diagnosing IE can be challenging, as shown by the evolution of original diagnostic criteria. Managing IE is difficult, involving decisions about diagnosis, antibiotic therapy, and surgery. Given these challenges, the 2015 European Society of Cardiology (ESC) IE Guidelines recommended establishing an endocarditis team (ET) in centres managing IE. This review evaluates the evidence supporting ETs.

Areas Covered

We identified nineteen before-and-after studies including 5,327 patients (3,069 before and 2,258 after ET introduction) that examined the impact of implementing an ET on the quality of care for patients with IE. No RCTs were found. The studies were reviewed and revealed a significant reduction in in-hospital mortality (20.9% to 16.3% [RR 0.71, CI 0.54 to 0.93], p=0.0154)) and the proportion of endocarditis cases in which an organism was not identified (23.8% to 9.8%; [RR 0.50, 0.39 to 0.64, p<0.0001]) following ET introduction.

Expert Opinion

This review provides consistent observational evidence that ETs are effective in saving lives. Despite limitations, the consistency of effect across multiple studies, biological plausibility, and alignment with successful multidisciplinary models in other diseases support the widespread implementation of ETs.