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Impact of a structured patient education programme on early diagnosis of prosthetic pulmonary valve endocarditis

Part of: Echocardiography

Published online by Cambridge University Press:  10 November 2021

Daniela Babic ,
Ramona Hämmerli ,
Bruno Santos Lopes ,
Christine Attenhofer Jost ,
Daniel Tobler Open the ORCID record for Daniel Tobler [Opens in a new window] ,
Markus Schwerzmann ,
Barbara Hasse ,
Francesca Bonassin Tempesta  and
Matthias Greutmann Open the ORCID record for Matthias Greutmann [Opens in a new window]
Daniela Babic
Affiliation:
Department of Cardiology, University Heart Center, University of Zurich, Zurich, Switzerland
Ramona Hämmerli
Affiliation:
Department of Cardiology, University Heart Center, University of Zurich, Zurich, Switzerland
Bruno Santos Lopes
Affiliation:
Department of Cardiology, University Heart Center, University of Zurich, Zurich, Switzerland
Christine Attenhofer Jost
Affiliation:
Department of Cardiology, University Heart Center, University of Zurich, Zurich, Switzerland
Daniel Tobler
Affiliation:
Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
Markus Schwerzmann
Affiliation:
Center for congenital heart disease, University Hospital Inselspital, University of Bern, Bern, Switzerland
Barbara Hasse
Affiliation:
Division of Infectious diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
Francesca Bonassin Tempesta
Affiliation:
Department of Cardiology, University Heart Center, University of Zurich, Zurich, Switzerland
Matthias Greutmann*
Affiliation:
Department of Cardiology, University Heart Center, University of Zurich, Zurich, Switzerland
*
Author for correspondence: M. Greutmann, MD, Department of Cardiology, University Heart Center, University of Zurich, Raemistrasse 100, 8091Zurich, Switzerland. Tel: ++41 44 255 3883; Fax: ++41 44 255 8701. E-mail: [email protected]
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Abstract

Background:

Infective endocarditis is a major threat after prosthetic pulmonary valve replacement. Early diagnosis may improve outcomes.

Methods:

A structured patient education programme for prevention and early diagnosis of infective endocarditis was developed at our institution since 2016. Time delay between onset of symptoms of prosthetic pulmonary valve endocarditis and its diagnosis (defined as initiation of appropriate high-dose intravenous antibiotic treatment) was compared for patients presenting before (cohort 1) and after (cohort 2) initiation of the patient education programme.

Results:

Between 2008–2019, 26 patients (median age 24.9, range: 16.8–62.0 years, 73% male) were diagnosed with prosthetic pulmonary valve endocarditis, 13 patients (cohort 1) before (1.7 cases/year) and 13 patients (cohort 2) after June 2016 (3.7 cases/year). There were no differences in baseline characteristics or clinical presentation between the study cohorts. Overall, the median delay between onset of symptoms and diagnosis of infective endocarditis was 6 days (range: 0–133 days) with a significantly longer delay among patients in cohort 1, compared to cohort 2 (25 days, range: 5–133 days versus 3 days, range: 0–13 days, p < 0.0001). A delay of >7 days was documented in 11/13 patients (85%) in cohort 1 as compared to 1/13 (8%) in cohort 2 (p < 0.001). Need for urgent valve replacement or permanent deterioration of prosthetic valve function was higher in cohort 1, compared to cohort 2 (11/13, 85% versus 5/13, 39%; p = 0.041).

Conclusions:

Prosthetic pulmonary valve endocarditis is increasingly recognised. A structured patient education programme may improve early diagnosis and clinical outcomes.

Keywords

Pulmonary valve replacementinfective endocarditistetralogy of FallotRoss operation
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 10 , October 2022 , pp. 1564 - 1569
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Social Media Synopsis: Patient education leads to earlier diagnosis and improves outcomes of prosthetic pulmonary valve endocarditis: Lessons learnt from a single centre experience.

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