After 2007 Heart Association Recs, Increase Seen in Infective Endocarditis

There was a 20% drop in antibiotic prophylaxis, 177% increase in IE incidence for high-risk.
There was a 20% drop in antibiotic prophylaxis, 177% increase in IE incidence for high-risk.

HealthDay News — Following the 2007 American Heart Association (AHA) update of recommendations for antibiotic prophylaxis (AP) to prevent infective endocarditis (IE), there has been a decrease in AP and an increase in IE incidence for high-risk individuals, according to a study published online November 5 in the Journal of the American College of Cardiology. The research was published to coincide with the annual meeting of the American Heart Association, held from November 10 to 12 in Chicago.

Martin H. Thornhill, MBBS, PhD, from the University of Sheffield in the United Kingdom, and colleagues examined any change in AP prescribing and IE incidence using data for high-, moderate-, and unknown/low-risk individuals with linked prescription and Medicare or commercial health care data (198,522,665 enrollee-years of data). 

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The researchers found that the 2007 recommendation change was associated with a significant 64% estimated decrease in AP prescribing for moderate-risk individuals and a 20% estimated decrease for high-risk individuals by August 2015. During the same period, there was a barely significant 75% estimated increase and a significant 177% increase in IE incidence among those at moderate and high risk, respectively. A significant 52% decrease was seen in AP prescribing among unknown/low-risk individuals, but there was no significant increase in IE incidence.

"Although the data do not prove a cause-effect relationship between AP reduction and IE increase, they are very supportive of the AHA recommendation to give AP to those at high risk but not to those at moderate risk of endocarditis," Thornhill said in a statement.

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