Transfer of patients with infective endocarditis to reference centers: an analysis of patients’ profile and the influence of timing on outcomes

Abstract Purpose The 2015 European infective endocarditis (IE) guidelines recommend the management of patients with IE in reference centers (RC), especially in cases of IE complicated by heart failure, abscesses, embolisms, or neurological complications. This management strategy has demonstrated a reduction in mortality. Methods From January 1996 to December 2021, 1834 episodes with a final diagnosis of IE admitted in three tertiary centers were prospectively included in a multicenter, multipurpose registry. Results In a cohort of 1688 patients with left-sided infective endocarditis, prolonged time from diagnosis to surgery was independently associated with higher mortality in referred patients. This did not occur in patients diagnosed directly in the Reference Center, probably reflecting better risk stratification and selection of surgical timing in these centers. Conclusion Prompt referral of IE cases to RCs is a measure that may improve patients’ prognosis by allowing access to specialized management by dedicated teams of experts and cardiac surgery.