Infective endocarditis at the Presbyterian Hospital in New York City from 1938–1967

• Published in: The American Journal of Medicine Vol. 51; no. 1; pp. 83 - 96
• Main Authors: Cherubin, C.E., Neu, H.C.
• Format: Book Review Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.1971
• Subjects: Adult; Anti-Bacterial Agents - therapeutic use; Cardiac Surgical Procedures - adverse effects; Endocarditis - drug therapy; Endocarditis - epidemiology; Endocarditis - etiology; Endocarditis - microbiology; Endocarditis, Bacterial - drug therapy; Endocarditis, Bacterial - epidemiology; Endocarditis, Bacterial - etiology; Endocarditis, Bacterial - microbiology; Female; Heart Auscultation; Humans; Male; Middle Aged; Mycoses - epidemiology; Mycoses - etiology; New York City; Retrospective Studies; Rheumatic Heart Disease - complications; Substance-Related Disorders - complications; New York City
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/0002-9343(71)90326-3

The medical records of 656 cases of infective endocarditis seen at the Columbia Presbyterian Medical Center, 1938–1967, were reviewed. Only a small decline in the number of cases has occurred over the thirty years. The mean age of patients has risen from thirty-one years in 1938 to fifty-two years by 1966. The frequency of a history of previous rheumatic fever has declined over the three decades whereas a history of murmur of unknown etiology has increased. The addition of narcotic addicts, patients who have undergone cardiac surgery and patients who have survived a previous episode of endocarditis has resulted in an increase in staphylococcal and fungal endocarditis in recent years. Neisseria and Diplococcus pneumoniae have essentially disappeared as causes of endocarditis at this hospital since the introduction of penicillin. Streptococcus viridans remains the most common etiologic agent, but enterococcal endocarditis has shown a significant increase. Abacteremic cases constitute about 12 per cent of the patients. Aortic valve involvement has markedly increased over the three decades, mitral valve involvement has shown a slight decline, and there has been a marked decline in combined mitral and aortic disease. The duration of symptoms prior to diagnosis has shortened; as a result, splenomegaly, petechiae and clinical evidence of major embolization are less frequently encountered today. The introduction of antibiotics has been the major factor in determining the outcome of the disease. Survival with Strep, viridans endocarditis has been excellent, with only minimal improvement in the last five years. Enterococcal endocarditis continues to have a bad prognosis, but survival rates in staphylococcal endocarditis have continued to show improvement over the past decade. The decline in rheumatic fever, the increased age of the patients with endocarditis, sophisticated medical and surgical procedures and the prolonged survival of patients with rheumatic heart disease have all been major factors in changing the nature of infective endocarditis. The particular effects of changes in the community population and the relations of the teaching hospital to the community on the nature of bacterial endocarditis are noted.