{"id":"92d5f10fca64","type":"article","url":"https://hartvaat.nl/2026/01/09/endocarditis-van-de-natieve-klep-verschuift-naar-ouderen-chirurgie-blijft-levens/","title":"Endocarditis van de natieve klep verschuift naar ouderen — chirurgie blijft levens redden (Korea, 18 jaar)","title_en":"Changing epidemiology and outcomes of native valve infective endocarditis: a nationwide study, 2006-2023","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-hartfalen","bradycardie","endocarditis","slaapapneu"],"journal":"Open Heart","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e003764?rss=1","source_url":"https://doi.org/http://openheart.bmj.com/cgi/content/short/13/1/e003764?rss=1","authors":["Kim","D. Y.","Kim","M.-J.","Lee","J.","Kim","K. A.","Jung","H. O.","Yoon","J. S.","Jeon","D. S."],"significance":6,"published":"2026-01-09","source_date":"2026-01-09","image":"","kennis":["https://hartvaat.nl/kennis/vasculair/pulmonale-hypertensie/","https://hartvaat.nl/kennis/kleplijden/endocarditis-profylaxe/"],"congress":"","summary_en":"The epidemiology of native-valve infective endocarditis (IE) is shifting toward older patients with substantial comorbidity. In this 18-year nationwide Korean cohort (18,402 adults with native-valve IE, 2006-2023), incidence fell in those <45 but rose in those ≥65. In-hospital mortality was 25.5% and 5-year mortality exceeded 50%. Older age, dialysis, cancer and major complications predicted mortality. Valve surgery, performed in 29.1%, was consistently associated with lower short- and long-term mortality across all age groups, with no age-by-treatment interaction; both early (≤7 days) and late surgery improved survival. Relapse was also less frequent after surgery. Despite declining use, surgery's survival benefit was preserved across the age spectrum — supporting operative consideration even in selected older patients.","created":"2026-07-03T10:32:27Z","updated":"2026-07-03T18:39:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De epidemiologie van endocarditis (IE) van de natieve hartklep verschuift naar oudere patiënten met veel comorbiditeit. In dit 18-jarige landelijke Koreaanse cohort (18.402 volwassenen met natieve-klep-IE, 2006-2023) daalde de incidentie bij <45-jarigen maar steeg die bij 65-plussers. De ziekenhuissterfte was 25,5% en de 5-jaarssterfte overschreed 50%. Hogere leeftijd, dialyse, kanker en majeure complicaties voorspelden sterfte. Klepchirurgie, uitgevoerd bij 29,1%, was in alle leeftijdsgroepen consistent geassocieerd met een lagere korte- en langetermijnsterfte, zonder interactie tussen leeftijd en behandeling; zowel vroege (≤7 dagen) als late chirurgie verbeterde de overleving. Ook recidieven kwamen minder voor na chirurgie. Ondanks het dalende gebruik bleef het overlevingsvoordeel van chirurgie behouden over het hele leeftijdsspectrum — wat een operatieve afweging ook bij geselecteerde oudere patiënten ondersteunt.","abstract_original":"<sec><st>Background</st>\n<p>The epidemiology of native valve infective endocarditis (IE) has shifted toward older adults with substantial comorbidity burdens, yet contemporary nationwide data on outcomes and surgical impact remain limited.</p>\n</sec>\n<sec><st>Methods</st>\n<p>We conducted an 18-year nationwide cohort study of adults hospitalised with native valve IE in Korea (2006&ndash;2023). Outcomes included in-hospital and 5-year all-cause mortality, IE relapse and a composite of death or relapse. Temporal trends, mortality predictors and surgical associations across age strata were evaluated using multivariable Cox models and stratified survival analyses.</p>\n</sec>\n<sec><st>Results</st>\n<p>Among 18 402 patients (mean age 63.7 years), incidence declined in individuals &lt;45 years but increased in those &ge;65 years. In-hospital mortality was 25.5%, and 5-year mortality exceeded 50% overall. Advanced age, dialysis dependence, cancer and major complications predicted mortality. Valve surgery, performed in 29.1% of patients, was consistently associated with lower short- and long-term mortality across age groups, with no evidence of age-by-treatment interaction. Both early (&le;7 days) and late (&gt;7 days) surgery showed reduced mortality versus medical therapy. IE relapse was more frequent in older adults, and surgery was associated with a lower relapse risk. In the composite outcome of death or relapse, older adults had a higher event burden, whereas surgery remained associated with fewer composite events.</p>\n</sec>\n<sec><st>Conclusions</st>\n<p>Native valve IE in Korea has shifted toward an elderly, multimorbid population with persistently high mortality. Despite declining utilisation, the survival benefit of surgery was preserved across the age spectrum, supporting operative consideration in appropriately selected older adults.</p>\n</sec>"}