Epidemiology and health burden of infective endocarditis: a comparative analysis of Australian vs global trends from 1990 to 2021.

Background

Infective endocarditis (IE) is an uncommon but life-threatening disease with evolving patient risk profiles and management strategies. However, its impact on the Australian healthcare system has not been described.

Aims

To quantify the healthcare burden of IE in Australia over time in the past three decades and compare outcomes with global and high-income settings.

Methods

Data extracted from Global Burden of Disease 2021 included IE prevalence, mortality, disability-adjusted life years (DALY), and heart failure (HF) attributed to IE from 1990 to 2021. Each metric was further indexed to age-adjusted prevalence and expressed as summary rates per 100 IE cases (e.g. prevalence-adjusted mortality rate), and were stratified by geographical groups (Australia, Global and High-Income), sex and 5-year age groups.

Results

Between 1990 and 2021, 8 563 131 IE cases were reported worldwide, with 0.74% occurring in Australia. In Australia, age-adjusted prevalence rates of IE (AAPR) quadrupled over time (AAPRAUS: 2.63-10.18 per 100 000 persons), whilst prevalence-adjusted mortality rates (PAMR) and disability rates (PADR) declined (PAMRAUS: 18.6-11.25 deaths per hundred cases; PADRAUS: 440-244 DALY per hundred cases). Australia reported a growth in prevalence-adjusted heart failure rates (PAHRAUS: 68.4-86.8 HF per hundred IE cases). Across all geographical groups, including Australia, bimodal peaks in mortality and disability affected middle-aged (40-64 years) and elderly populations (≥75 years). IE prevalence was relatively even between sexes; males experienced higher IE mortality and disability, while females experienced a greater burden of heart failure.

Conclusions

Australia's IE profile is distinct, with a sharper rise in prevalence and IE-associated heart failure, despite declining mortality and disability. These findings suggest improved survival but increasing chronic morbidity, underscoring the need for enhanced post-acute care models and further research to explore underlying drivers, including evolving risk factors, healthcare access and long-term cardiac outcomes.