Epidemiology and health burden of infective endocarditis: a comparative analysis of Australian vs global trends from 1990 to 2021.

BACKGROUND

Infective endocarditis (IE) is an uncommon but life-threatening disease with evolving patient risk profiles and management strategies. However, its impact on the Australian healthcare system has not been described.

AIMS: To quantify the healthcare burden of IE in Australia over time in the past three decades and compare outcomes with global and high-income settings.

METHODS

Data extracted from Global Burden of Disease 2021 included IE prevalence, mortality, disability-adjusted life years (DALY), and heart failure (HF) attributed to IE from 1990 to 2021. Each metric was further indexed to age-adjusted prevalence and expressed as summary rates per 100 IE cases (e.g. prevalence-adjusted mortality rate), and were stratified by geographical groups (Australia, Global and High-Income), sex and 5-year age groups.

RESULTS

Between 1990 and 2021, 8 563 131 IE cases were reported worldwide, with 0.74% occurring in Australia. In Australia, age-adjusted prevalence rates of IE (AAPR) quadrupled over time (AAPRAUS: 2.63-10.18 per 100 000 persons), whilst prevalence-adjusted mortality rates (PAMR) and disability rates (PADR) declined (PAMRAUS: 18.6-11.25 deaths per hundred cases; PADRAUS: 440-244 DALY per hundred cases). Australia reported a growth in prevalence-adjusted heart failure rates (PAHRAUS: 68.4-86.8 HF per hundred IE cases). Across all geographical groups, including Australia, bimodal peaks in mortality and disability affected middle-aged (40-64 years) and elderly populations (≥75 years). IE prevalence was relatively even between sexes; males experienced higher IE mortality and disability, while females experienced a greater burden of heart failure.

CONCLUSIONS

Australia's IE profile is distinct, with a sharper rise in prevalence and IE-associated heart failure, despite declining mortality and disability. These findings suggest improved survival but increasing chronic morbidity, underscoring the need for enhanced post-acute care models and further research to explore underlying drivers, including evolving risk factors, healthcare access and long-term cardiac outcomes.