32 Infective endocarditis: a review of the patient journey at a district general hospital (dgh)

Abstract

Introduction Infective endocarditis (IE) is a rare and potentially fatal infection. Patients often present with generalised symptoms resulting in delays in diagnosis. Complications are common and patients can have long inpatient stays due to intravenous antibiotic requirement. The POET study highlighted non inferiority of oral antibiotic switch in stable patients with left sided IE. The aim of our study is to characterise the IE patient population at our DGH, analyse their management, review adherence of our Endocarditis Team to the ESC 2015 guidelines (figure 1) and to review discharge information and advice, to identify areas for improvement. Methods This was a retrospective study of medical records for patients treated at our DGH with a diagnosis of IE between 1 Oct 2019 and 30 Sep 2020. Demographics, patient characteristics (table 1), IE risk factors, presentation, management, discharge information, patient feedback, and cost analysis was carried out. Adherence of our Endocarditis Team to ESC 2015 guidelines was reviewed. Results Between October 2019 and September 2020, 14 patients were diagnosed with IE according to the Duke Criteria. The median age was 75 (60-89) years and 68.7% of patients were male. 7 patients had a prosthetic valve and 3 had a cardiac device in situ. All patients had CVR risk factors, 50% had T2DM, 36% had renal disease. Only 2 patients had documentation of dental history. The majority of patients (n=12) presented via the Emergency Department. 86% of patients completed a 6-week antibiotic course. Only 14% of patients were managed as outpatients. 21% of patients required surgical management. All patients were reviewed by the Endocarditis Team. All patients were followed up appropriately. Only 1 patient had documented advice regarding dental care. 1 patient died and many patients had complications (figure 2). IE patient support group feedback highlighted concerns regarding delay in diagnosis, challenges of a long inpatient stay and benefits of hearing from other patients about their experiences. Conclusion IE is a rare disease. Documentation of some IE risk factors, and documented discharge advice was poor at our centre. Our Endocarditis Team meet weekly, have a significant input in IE patient management and ensure adequate follow up is arranged for patients. We plan to join an international IE registry. An IE ward round proforma has been created along with a teaching session for staff to improve awareness and understanding of IE. A discharge information pack including information on IE, dental advice and IE and dental warning cards has been created. We plan for a virtual IE support group given current COVID-19 restrictions. We plan to create an outpatient IE treatment pathway with potential for improvement in patient experience and potential for significant cost savings.