Duration of symptoms and the effects of a more aggressive surgical policy: two factors affecting prognosis of infective endocarditis

One hundred and six patients were analysed in order to assessthe effect of a more aggressive surgical policy in relationto the delays in diagnosis of infective endocarditis. The averageduration of symptoms before diagnosis was 9.7 weeks, even thoughthe patients had sought medical advice at a relatively earlystage of their illness (2.2 weeks). Three of the 29 (10.3%)patients who were treated surgically died and all three wereoperated upon five weeks or later after diagnosis. Seventy-sevenpatients did not have surgery and 15 died (19.5%). The outcome of surgical treatment for prosthetic valve endocarditiswas no worse than for native valve endocarditis. The mortalityof prosthetic valve endocarditis including early infectionswas 32% with medical but only 10% with surgical management comparedwith 14.5% and 10.5% in native valve endocarditis.Endocarditiscannot always be prevented but earlier diagnosis would reducemortality and prevent complications. When medical treatmentis failing then surgery should be considered early and urgentlyparticularly in staphylococcal infection or when large mobilevegetations are recognized; surgery is mandatory in fungal endocarditis.Earlier diagnosis would greatly reduce the current high incidenceof surgery, but that depends on a much heightened index of suspicionamongst both general practitioners and hospital physicians.