The economic and health burden of infective endocarditis in Northland, New Zealand.

AIM: To explore the epidemiology, presentation, management and healthcare impact of infective endocarditis (IE) in Northland, to guide strategies for prevention and quality improvement.

METHOD: Health records of patients treated for IE in Northland between 2010 and 2019 were analysed retrospectively. Cases were classified using Modified Duke Diagnostic Criteria.

RESULTS

One hundred and forty cases of IE (97 definite, 43 possible) were identified. The incidence of IE in Northland was 8.5 per 100,000-person-years. The highest-risk group were elderly Māori. There was a 44% rate of prosthetic valve endocarditis (PVE) with 27% of these patients having a history of rheumatic heart disease. Organisms causing IE included streptococcal species (43%), Staphylococcus aureus (23%) and enterococci (16%). Complications included stroke (24%), systemic embolism (38%), congestive heart failure (30%) and paravalvular abscess (14%). Median length of hospitalisation was 22 days (IQR 14-34) and 32% required valve surgery. The mortality rate at six weeks after diagnosis was 18%. An estimated total of NZ$6,560,470 was spent on direct patient care.

CONCLUSION

IE is causing substantial morbidity and mortality in Northland and consuming considerable healthcare resources. A high index of suspicion for IE is recommended. A high proportion of cases were caused by odontogenic organisms. Preventative investment in oral health promotion and dental care has the potential to be cost-effective.