There are no comprehensive studies that have looked at overall prognosis in patients with IE. Left-sided IE tends to have a poorer prognosis, with higher morbidity and mortality than right-sided IE.[6]Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation. 2015 Oct 13;132(15):1435-86.
http://circ.ahajournals.org/content/132/15/1435.full
http://www.ncbi.nlm.nih.gov/pubmed/26373316?tool=bestpractice.com
[7]Delgado V, Ajmone Marsan N, de Waha S, et al. 2023 ESC guidelines for the management of endocarditis. Eur Heart J. 2023 Oct 14;44(39):3948-4042.
https://academic.oup.com/eurheartj/article/44/39/3948/7243107
http://www.ncbi.nlm.nih.gov/pubmed/37622656?tool=bestpractice.com
Congestive heart failure remains the single greatest predictor of prognosis in patients, regardless of the offending microorganism. Other indicators of mortality include cerebral complications, vegetation length >10 mm, moderate to severe heart failure, bacterial etiology other than Viridans streptococci and failure to undertake surgery when indicated.[20]Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2021 Feb 2;143(5):e72-227.
https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000923
[130]Habib G, Erba PA, Iung B, et al. Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: a prospective cohort study. Eur Heart J. 2019 Oct 14;40(39):3222-32.
https://www.doi.org/10.1093/eurheartj/ehz620
http://www.ncbi.nlm.nih.gov/pubmed/31504413?tool=bestpractice.com
Surgery, if indicated, has been associated with a lower overall mortality; however, patients with definitive indications for surgery tend to be critically ill and carry a high intraoperative mortality rate.[20]Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2021 Feb 2;143(5):e72-227.
https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000923
[131]Sexton DJ, Spelman D. Current best practices and guidelines: assessment and management of complications of infective endocarditis. Cardiol Clin. 2003 May;21(2):273-82.
http://www.ncbi.nlm.nih.gov/pubmed/12874898?tool=bestpractice.com
As the population ages, IE is becoming more frequently seen, with trends towards worsening outcomes.[61]Selton-Suty C, Hoen B, Grentzinger A, et al. Clinical and bacteriological characteristics of infective endocarditis in the elderly. Heart. 1997 Mar;77(3):260-3.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC484694
http://www.ncbi.nlm.nih.gov/pubmed/9093046?tool=bestpractice.com
Mortality of IE in elderly patients is higher than in younger patients: age, cerebral embolism, and prosthetic valve endocarditis have been shown to be risk factors for the increased mortality.