Durante-Mangoni E et al. (2008) Current features of infective endocarditis in elderly patients. Results of the International Collaboration on Endocarditis Prospective Cohort Study Group. Arch Intern Med 168: 2095–2103

Individuals aged 65 years and older with infective endocarditis are at much greater risk of morbidity and mortality than younger people with the same condition. Durante-Mangoni et al. conducted a prospective, multicenter study to determine the clinical characteristics and prognosis of elderly patients with infective endocarditis.

A total of 2,759 participants were enrolled, 1,056 of whom were aged 65 years or older. Patients who contracted infective endocarditis through drug use and those with prosthetic intracardiac devices were excluded. In both older and younger patients, Staphylococcus aureus was the most common causative organism. Methicillin resistance was observed more often among older patients. Elderly patients were less likely than younger individuals to present with clinical signs of infective endocarditis, such as conjunctival hemorrhage, embolic events, and splenomegaly (P <0.001). Chronic illnesses, such as cancer and diabetes mellitus, were more common among the older patients (P <0.001). Individuals aged 65 years or older were more likely to have nonrheumatic aortic stenosis and mitral regurgitation (P <0.001 for both). Overall, dysfunction of the mitral valve was characteristic of elderly patients, whereas younger individuals were more likely to present with conditions of the aortic and tricuspid valves. In-hospital mortality among older patients was 24.9%, which was almost twice as high as in the younger group. Multivariate analysis revealed that age 65 years and older was strongly associated with fewer embolic complications, fewer surgical interventions, and higher in-hospital mortality.