Abstract Background The endocarditis team (ET) was introduced and recommended in the 2015 European Society of Cardiology guidelines on the management of infective endocarditis. At our institution, an ET was installed late 2015. Purpose To investigate the impact of the ET and temporal changes in management and outcomes of endocarditis patients. Methods All patients discussed from 2016 until 2025 were included. Patients were divided into cohorts: c1(2016-2018), c2(2019-2021) and c3(2022-2024). The primary outcome was survival. Secondary outcomes were number of discussions per patient, diagnostic use, diagnostic advice and treatment type. Treatment and mortality were analyzed for patients with definite or possible diagnosis. Groups were compared using Chi-square or Fisher’s exact for categorical and Kruskal-Wallis for non-parametrical numeric variables. Post-hoc analyses were performed between cohorts. Mortality is visualized with Kaplan Meier curves and compared with a log-rank test. Results The number of individual patients discussed in c1, c2 and c3 was 223, 366 and 453, respectively, table 1. Patients were more often discussed multiple times in c2 and c3 (both p0.001). The percentage of patients with positive blood cultures decreased significantly over time (c1 vs c3: p0.001, c2 vs c3 p0.001). Causative pathogen in patients with a definite/possible diagnosis did not change (p=0.74). The percentage of patients with positive imaging and CTA-scans performed were not significantly different between cohorts (p=0.20, p=0.15). Within patients with a CTA, scan results were significantly less often positive in c1 compared to c2 and c3 (both p=0.01). Contrarily, use of PET-CT significantly increased over time (c1 vs c3: p.001, c2 vs c3 p=0.004), while the percentage of positive scans remained stable (p=0.55). Additional diagnostic tests were significantly less often advised in c3 compared to c1 (p0.001). Treatment was not different between groups (conservative p=0.80, surgery p=0.77). Additional antibiotic advice was given less frequent in c3 (c2 vs c3 p=0.01). Urgent surgery indication significantly increased (c1 vs c2: p=0.016, c1 vs c3: p=0.002). Median follow-up time was 6.12.1-7.4, 3.61.2-4.7 and 1.00.2-1.9 years, respectively. Mortality significantly differed between types of endocarditis and treatment (both p0.0001), but not between cohorts (p=0.27), figure 1. Conclusion Mortality did not significantly change between the cohorts. Treatment type was also not significantly different, except that surgery was more often urgent. The use of PET-CT increased, but the percentage of positive scans did not. The results indicate an evolving role of the ET over time, with more discussions per patient and less need for additional diagnostic and antibiotic advice. The latter might indicate an educational effect. The decreased percentage of patients with positive blood might indicate a lower threshold for referring to the ET.Table 1 Figure 1
Dalebout et al. (Sat,) studied this question.