PT  - JOURNAL ARTICLE
AU  - Shakeel M Jamal
AU  - Asim Kichloo
AU  - Michael Albosta
AU  - Beth Bailey
AU  - Jagmeet Singh
AU  - Farah Wani
AU  - Muhammad Shah Zaib
AU  - Muhammad Ahmad
AU  - Muhammad Dilawar Khan
AU  - Ronak Soni
AU  - Michael Aljadah
AU  - Hafiz Waqas Khan
AU  - Mahin Khan
AU  - Muhammad Z Khan
TI  - In-hospital outcomes and prevalence of comorbidities in patients with infective endocarditis with and without heart blocks: Insight from the National Inpatient Sample
AID  - 10.1136/jim-2020-001501
DP  - 2021 Feb 01
TA  - Journal of Investigative Medicine
PG  - 358--363
VI  - 69
IP  - 2
4099  - http://hw-f5-jim.highwire.org/content/69/2/358.short
4100  - http://hw-f5-jim.highwire.org/content/69/2/358.full
SO  - J Investig Med2021 Feb 01; 69
AB  - Infective endocarditis (IE) complicated by heart block can have adverse outcomes and usually requires immediate surgical and cardiac interventions. Data on outcomes and trends in patients with IE with concurrent heart block are lacking. Patients with a primary diagnosis of IE with or without heart block were identified by querying the Healthcare Cost and Utilization Project database, specifically the National Inpatient Sample for the years 2013 and 2014, based on International Classification of Diseases Clinical Modification Ninth Revision codes. During 2013 and 2014, a total of 18,733 patients were admitted with a primary diagnosis of IE, including 867 with concurrent heart blocks. Increased in-hospital mortality (13% vs 10.3%), length of stay (19 vs 14 days), and cost of care ($282,573 vs $223,559) were found for patients with IE complicated by heart block. Additionally, these patients were more likely to develop cardiogenic shock (8.9% vs 3.2%), acute kidney injury (40.1% vs 32.6%), and hematologic complications (19.3% vs 15.2%), and require placement of a pacemaker (30.6% vs 0.9%). IE and concurrent heart block resulted in increased requirement for aortic (25.7% vs 6.1%) and mitral (17.3% vs 4.2%) valvular replacements. Conclusion was made that IE with concurrent heart block worsens in-hospital mortality, length of stay, and cost for patients. Our analysis demonstrates an increase in cardiac procedures, specifically aortic and/or mitral valve replacements, and Implantable Cardiovascular Defibrillator/Cardiac Resynchronization Therapy/ Permanent Pacemaker (ICD/CRT/PPM) placement in IE with concurrent heart block. A close telemonitoring system and prompt interventions may represent a significant mitigation strategy to avoid the adverse outcomes observed in this study.