Infective Endocarditis in the Elderly

We reviewed 56 cases of infective endocarditis (IE) in patients 65 years of age and older. The clinical features, laboratory manifestations, and bacterial etiology of IE in our patients were similar to those in younger patients. Ninety-three percent were febrile, 86% had heart murmurs, and 36% had peripheral stigmas. Streptococci were predominant in community-acquired cases and staphylococci in nosocomial infections; most patients (89%) had persistent bacteremia. Preexisting valvulitis was present in only 23% of patients; 34% had evidence of atherosclerotic heart disease. Complications included congestive heart failure (CHF) in 64%, neurologic sequelae in 36%, and myocardial infarction in 13%. The mortality rate was 45%. A significantly increased mortality was associated with neurologic sequelae, myocardial infarction, or IE with Staphylococcus aureus. The diagnosis of IE should be considered in any elderly patient with a fever, heart murmur, worsening CHF, or an acute cerebrovascular insult.