Abstract：
OBJECTIVE: Our aim was to describe the contemporary epidemiological profile of infective endocarditis (IE) in Spain, and to evaluate variations in IE incidence, characteristics, and outcomes among the different Spanish regions (autonomous communities [AC]).
METHODS: We conducted a retrospective, population-based study, using data obtained from national in-patient hospital activity of all patients discharged with a diagnosis of IE from hospitals included in the Spanish National Health System, from January 2016 to December 2019. Differences in the IE profile between the 17 Spanish AC were analyzed.
RESULTS: A total of 9008 hospitalization episodes were identified during the study period. Standardized incidence of IE was 5.77 (95%CI, 5.12-6.41) cases per 100 000 population. Regarding predisposing conditions, 26.8% of episodes occurred in prosthetic valve carriers, 36.8% had some kind of valve heart disease, and 10.6% had a cardiac implantable electronic device. Significant differences were found between AC in terms of incidence, predisposing conditions, and microbiological profile. Cardiac surgery was performed in 19.3% of episodes in the total cohort, and in 33.4% of the episodes treated in high-volume referral centers, with wide variations among AC. Overall in-hospital mortality was 27.2%. Risk-adjusted mortality rates also varied significantly among regions.
CONCLUSIONS: We found wide heterogeneity among Spanish AC in terms of incidence rates and the clinical and microbiological characteristics of IE episodes. The proportion of patients undergoing surgery was low and in-hospital mortality rates were high, with wide differences among regions. The development of regional networks with referral centers for IE could facilitate early surgery and improve outcomes.
METHODS: We conducted a retrospective, population-based study, using data obtained from national in-patient hospital activity of all patients discharged with a diagnosis of IE from hospitals included in the Spanish National Health System, from January 2016 to December 2019. Differences in the IE profile between the 17 Spanish AC were analyzed.
RESULTS: A total of 9008 hospitalization episodes were identified during the study period. Standardized incidence of IE was 5.77 (95%CI, 5.12-6.41) cases per 100 000 population. Regarding predisposing conditions, 26.8% of episodes occurred in prosthetic valve carriers, 36.8% had some kind of valve heart disease, and 10.6% had a cardiac implantable electronic device. Significant differences were found between AC in terms of incidence, predisposing conditions, and microbiological profile. Cardiac surgery was performed in 19.3% of episodes in the total cohort, and in 33.4% of the episodes treated in high-volume referral centers, with wide variations among AC. Overall in-hospital mortality was 27.2%. Risk-adjusted mortality rates also varied significantly among regions.
CONCLUSIONS: We found wide heterogeneity among Spanish AC in terms of incidence rates and the clinical and microbiological characteristics of IE episodes. The proportion of patients undergoing surgery was low and in-hospital mortality rates were high, with wide differences among regions. The development of regional networks with referral centers for IE could facilitate early surgery and improve outcomes.
摘要：
目的：我们的目的是描述西班牙感染性心内膜炎（IE）的当代流行病学概况，并评估IE发病率的变化，特点,以及西班牙不同地区(自治区[AC])之间的结果。
方法：我们进行了回顾性研究，基于人群的研究，使用从西班牙国家卫生系统中包括的医院诊断为IE的所有出院患者的国家住院医院活动获得的数据，从2016年1月到2019年12月。分析了17个西班牙AC之间的IE概况差异。
结果：研究期间共发现9008次住院。IE的标准化发生率为每10万人口5.77例（95CI，5.12-6.41）。关于易感条件，26.8%的发作发生在人工瓣膜载体上,36.8%有某种瓣膜性心脏病,10.6%的患者有心脏可植入电子设备。就发病率而言，AC之间存在显着差异，易感条件,和微生物概况。在整个队列中，心脏手术的发生率为19.3％，在高容量转诊中心治疗的事件中，有33.4％，AC之间的差异很大。总体住院死亡率为27.2%。风险调整后的死亡率在各地区之间也有很大差异。
结论：我们发现西班牙AC在IE发作的发病率以及临床和微生物学特征方面具有广泛的异质性。手术病人比例低,院内死亡率高,地区间差异很大。建立具有IE转诊中心的区域网络可以促进早期手术并改善预后。
方法：我们进行了回顾性研究，基于人群的研究，使用从西班牙国家卫生系统中包括的医院诊断为IE的所有出院患者的国家住院医院活动获得的数据，从2016年1月到2019年12月。分析了17个西班牙AC之间的IE概况差异。
结果：研究期间共发现9008次住院。IE的标准化发生率为每10万人口5.77例（95CI，5.12-6.41）。关于易感条件，26.8%的发作发生在人工瓣膜载体上,36.8%有某种瓣膜性心脏病,10.6%的患者有心脏可植入电子设备。就发病率而言，AC之间存在显着差异，易感条件,和微生物概况。在整个队列中，心脏手术的发生率为19.3％，在高容量转诊中心治疗的事件中，有33.4％，AC之间的差异很大。总体住院死亡率为27.2%。风险调整后的死亡率在各地区之间也有很大差异。
结论：我们发现西班牙AC在IE发作的发病率以及临床和微生物学特征方面具有广泛的异质性。手术病人比例低,院内死亡率高,地区间差异很大。建立具有IE转诊中心的区域网络可以促进早期手术并改善预后。
