A new study published in The Lancet has identified a dramatic increase in cases of infective endocarditis (IE) in England since 2009.
The researchers used publicly available annual admission data for hospitals in England to examine the incidence of IE admissions between 1998 and 2019.
The data showed stable incidence between 1998-1999 (26.6 cases per million) and 2009-2010 (26.9 cases per million), but an 86% increase to 50.0 cases per million in 2018-2019.
Most healthy individuals are at low risk for IE, but those with artificial or repaired heart valves, certain congenital heart problems or a previous history of IE are at particularly high risk. In Europe and the US, patients at high risk are given antibiotic prophylaxis when undergoing invasive dental procedures, but this ceased being recommended UK guidance in 2008.
The study highlights that there are a number of possible reasons why cases of IE might be increasing, including: an ageing population, increasing use of artificial heart valves and other cardiac and vascular devices, changes in the type of bacteria that cause IE, increased injecting drug use, greater clinical awareness of IE and the changes in prevention guidelines.
Study senior author Dr Martin Thornhill said: “It is notable that incidence of IE is falling in the US and is stable or rising more slowly in the rest of Europe, where many of the factors that might explain an increase in IE are similar to here.”
While saying it is unclear what part of not offering antibiotic prophylaxis or any of the other factors played in the large increase in IE cases in England, he added “the increase is very worrying and we need to thoroughly investigate all the possible reasons for the increase so that the cause can be identified and appropriate action taken to protect those at high risk of IE.”
