Infective endocarditis: a third of patients had new or changed murmurs.

Clinical bottom line (level 4)

  1. 39% of patients had either a new or changed murmur at first clinical examination.
  2. Valvular heart disease was common.
Hogevik et al: Medicine 1995; 74: 324-339
Expires July 2003

The study

Case series with ?objective ?blinded outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital, Sweden, 1984 to 1988

89 patients (aged median 69 years, 52% female) adults with 98 episodes of infective endocarditis diagnosed using modified Von Reyn criteria

Excluded if
  • not fulfilling von Reyn criteria
  • not living in the area of Goteburg between 1984 and 1988





    • Outcomes studied:
  • unchanged murmur at 1st examination
  • new murmur at ist examination
  • changed murmur at 1st examination
  • no murmur at 1st examination
  • risk factor: heart surgery
  • risk factor: history of rheumatic fever
  • risk factor: previous infective endocarditis
  • risk factor: valvular prosthesis
  • risk factor: unclassified murmur
  • risk factor: congenital anomalies
  • risk factors: mechanical prosthesis
  • risk factor: bicuspid aortic valve
  • risk factor: mitral valve prolapse
  • risk factor: iv drug abuse
  • risk factor: bioprosthesis

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    unchanged murmur at 1st examination ? / 35%
    (26% to 45%)
    new murmur at ist examination ? / 29%
    (20% to 38%)
    changed murmur at 1st examination ? / 10%
    (4% to 16%)
    no murmur at 1st examination ? / 24%
    (16% to 33%)
    risk factor: heart surgery ? / 22%
    (14% to 31%)
    risk factor: history of rheumatic fever ? / 18%
    (11% to 26%)
    risk factor: previous infective endocarditis ? / 14%
    (7% to 21%)
    risk factor: valvular prosthesis ? / 15%
    (8% to 22%)
    risk factor: unclassified murmur ? / 15%
    (8% to 22%)
    risk factor: congenital anomalies ? / 10%
    (4% to 16%)
    risk factors: mechanical prosthesis ? / 10%
    (4% to 16%)
    risk factor: bicuspid aortic valve ? / 7%
    (2% to 12%)
    risk factor: mitral valve prolapse ? / 7%
    (2% to 12%)
    risk factor: iv drug abuse ? / 7%
    (2% to 12%)
    risk factor: bioprosthesis ? / 5%
    (1% to 9%)

    • Definite infective endocarditis was diagnosed in 33 episodes, probable infective endocarditis in 35 episodes, and possible infective endocarditis in 31 episodes. No indication as to the percentage in each category.
    • Transoesophageal echocardiography was not available during the study period.
    • Intravenous drug abusers (IVDU) had a median age of 33 years, compared to 70 years for non-IVDUs.
    • The crude incidence was calculated in the city of Goteburg to be 6.2 episodes/100,000 inhabitants per year.

    Citation

    1. Hogevik H, Olaison R, Anderson J, et al: Epidemiologic aspects of infective endocarditis in an urban population. Medicine 1995; 74: 324-339
    Search Terms: explode 'infective, endocarditis and epidemiology'
    Contributor: Carl Heneghan, Sumit Dhingra and Chris Ball, July 2000
    Reviewer:

    Clinical Question.
    Patient suspected endocarditis
    Intervention or Exposure clinical findings
    Outcome prevalence