Multidisciplinary Teams Improve Outcomes in Patients With Infective Endocarditis

Results of a study published in Open Forum Infectious Diseases suggest that there is a significant association between dedicated care via multidisciplinary teams (MDT) and improved short-term mortality outcomes in patients with infective endocarditis.

Researchers conducted a systematic review and meta-analysis to evaluate the effect of MDT management on outcomes in patients with infective endocarditis. Studies included in the analysis comprised hospitalized patients with infective endocarditis and were designed to examine short- or long-term mortality, morbidity complications, length of hospitalization, treatment adherence, patient satisfaction, and surgical outcomes. Restricted maximum likelihood random-effects models were used to calculate unadjusted risk ratios (RRs) and 95% CIs.

The final analysis included 18 studies, representing a total of 3993 episodes of IE. Among the studies, sample sizes ranged between 6 and 645 patients, the mean age was 41.1 years, and 29.7% of the population were women. All studies had a single-center design, 44% were retrospective, and most (83%) were conducted at either tertiary care facilities or reference centers for infective endocarditis.

In regard to MDT composition, all teams included cardiac surgery and most included cardiology and infectious diseases; other common specialties included neurology, echocardiography/radiology, and microbiology.

In the meta-analysis, data captured from 15 studies showed reduced risk for in-hospital mortality among patients who did vs did not receive care from dedicated MDT (RR, 0.61; 95% CI, 0.47-0.78). Multivariate analyses performed in 8 studies indicated an independent associated between dedicated care via MDT and reduced mortality. This association was preserved in 3 studies in which results were adjusted by calendar year and in 2 that included propensity score matching.

In 11 studies with data available on outcomes following MDT implementation, length of hospitalization was increased in 6 (55%) and reduced in 5 (45%), though results from only 4 studies were significant. Reductions in time to surgery and increased rates of surgery were also reported following MDT implementation.

Limitations of this analysis include potential residual confounding and selection bias as most studies had single-center observational designs. Other limitations include moderate heterogeneity, the small number of women, and a lack of generalizability as most studies were conducted in high-income countries.

According to the researchers, “Publishing guidance on a standardized framework for MDT management could be helpful, especially if such guidelines were to include meaningful outcome definitions to be used in future observational, quasi-experimental, and randomized studies.”

This article originally appeared on Infectious Disease Advisor