U.S. Infective Endocarditis Mortality Shows Complex Trends, Study Finds

WASHINGTON — A retrospective study analyzing CDC WONDER mortality data revealed that progress in reducing infective endocarditis deaths in the U.S. has been inconsistent and may reflect worsening disparities across demographic and geographic groups, according to Mariapaula Ordonez Giraldo, MD, of AdventHealth Sebring.

National age-adjusted infective endocarditis mortality rates remained nearly unchanged from 1999 to 2024, hovering around 4.1–4.2 deaths per 100,000 people.

However, mortality trends followed a non-linear trajectory: stable or slightly increasing between 1999 and 2005, declining significantly from 2005 to 2009, remaining stable from 2009 to 2018, sharply rising from 2018 to 2021, then decreasing again from 2021 to 2024.

Subgroup analysis highlighted inequities, revealing worsening outcomes for younger and middle-aged adults, men, and non-metropolitan populations during the study period:

• Adults aged 15–44 years experienced an increase in mortality (from 0.60 to 0.84 per 100,000), while those ≥65 years saw a decline (26.07 to 23.59 per 100,000).
• Mortality rose among men (4.64 to 4.90 per 100,000), contrasting with a decrease in women (3.95 to 3.41 per 100,000).
• Non-metropolitan areas reported increasing deaths (4.35 to 4.95 per 100,000), while metropolitan regions saw a decline (4.23 to 4.02 per 100,000).

“One key takeaway is that national averages can obscure critical differences across populations,” said Ordonez Giraldo, who presented findings at the IDWeek annual meeting. “These patterns demand further investigation to understand the underlying mechanisms.”

The study noted limitations in its dataset, which lacked individual-level clinical and behavioral data. Additionally, deaths in the database included cases where infective endocarditis was listed as a contributing condition on death certificates, not necessarily the primary cause.

Ordonez Giraldo suggested that rising mortality among younger adults may connect to broader trends in injection-drug use and evolving risk factors.

Disruptions during the COVID-19 pandemic likely influenced outcomes. Early in the pandemic, patients may have delayed care, while later cases showed increased complexity and poorer outcomes post-infection, she explained.

Effective management of infective endocarditis requires rapid diagnosis and coordinated care involving infectious disease specialists, cardiologists, and cardiac surgeons. Expanding access to these services, particularly in underserved areas, and integrating substance-use disorder treatment could improve outcomes, she emphasized.

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