713 - The Clinical Impact of Implementation of a Multidisciplinary Endocarditis Team

Presenting Author(s)

SE

Sami El-Dalati

Clinical Assistant Professor
University of Pittsburgh Medical Center
Ann Arbor, Michigan
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

DC

Daniel Cronin

Assistant Professor
University of Michigan
Ann Arbor, Michigan
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JR

James Riddell IV

Professor
University of MIchigan
Ann Arbor, Michigan
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MS

Michael Shea

Professor
University of MIchigan
Ann Arbor, Michigan
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
RW

Richard Weinberg

Assistant Professor
University of Michigan
Ann Arbor, MI
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
LW

Laraine Washer

Assistant Professor
University of MIchigan
Ann Arbor, Michigan
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
ES

Emily Stoneman

Assistant Professor
University of MIchigan
Ann Arbor, Michigan
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DP

D. Alexander Perry

Fellow
University of MIchigan
Ann Arbor, Michigan
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Suzanne F. Bradley

Professor of Internal Medicine
University of Michigan Medical School
Ann Arbor, Michigan
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JB

James Burke

Assistant Professor
University of MIchigan
Ann Arbor, Michigan
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SM

Sadhana Murali

Assistant Professor
University of MIchigan
Ann Arbor, Michigan
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CF

Christopher Fagan

House Officer
University of Michigan
Ann Arbor, MI
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
RC

Rishi Chanderraj

Clinical Instructor
University of Michigan
Ann Arbor, MI
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Paul J. Christine

Chief Resident
University of Michigan
Ann Arbor, MI
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
TP

Twisha S. Patel

Clinical Pharmacist, Antimicrobial Stewardship Program
Michigan Medicine
Ann Arbor, MI
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SF

Shinichi Fukuhara

Assistant Professor
University of Michigan Frankel Cardiovascular Center
Ann Arbor, MI
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MR

Matthew Romano

Assistant Professor
University of MIchigan
Ann Arbor, Michigan
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
BY

Bo Yang

Assistant Professor
University of MIchigan
Ann Arbor, Michigan
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MD

Michael Deeb

Professor
University of MIchigan
Ann Arbor, Michigan
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Infectious endocarditis is associated with substantial in-patient mortality of 15-20%. Effective management requires coordination between multiple medical and surgical subspecialties which can often lead to disjointed care. Previous European studies have identified multidisciplinary endocarditis teams as a tool for reducing endocarditis mortality.

Methods: The University of Michigan Multidisciplinary Endocarditis Team was formed on May 3^rd, 2018. The group developed an evidence-based algorithm for management of endocarditis that was used to provide recommendations for hospitalized patients over a 1-year period. Mortality outcomes were then retroactively assessed and compared to a historical control that was identified using an internal research tool.Figure 1

Table 1

Results: Between June 14^th, 2018 and June 13^th,2019 the team provided guideline-based recommendations on 56 patients with Duke Criteria definite endocarditis and at least 1 American Heart Association indication for surgery. The historical control included 68 patients with definite endocarditis and surgical indications admitted between July 1^st, 2014 to June 30^th, 2015. In-hospital mortality decreased significantly from 29.4% in 2014-2015 to 7.1% in 2018-2019 (p< 0.0001). There was a non-significant increase in the rate of surgical intervention after implementation of the team (41.2% vs 55.4%; p=0.12).Table 2

Table 3

Table 4

Conclusion: Implementation of a multidisciplinary endocarditis team was associated with a significant 1-year decrease in all-cause in-hospital mortality for patients with definite endocarditis and surgical indications. In conjunction with previous studies demonstrating their effectiveness, this data supports that widespread adoption of endocarditis teams in North America has the potential to improve outcomes for this patient population.Table 5