July 11, 2012Volume 7 - Issue 28

DynaMed Weekly Update

For the week ending July 6, 2012

Last week 441 articles were evaluated via DynaMed's Systematic Literature Surveillance and 146 were added to DynaMed content.   

 

Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update.

Feature Article

Early Surgery Reduces Embolic Events in Selected Patients with Native Valve Infective Endocarditis

 

Antibiotics are the standard treatment for native valve infective endocarditis with surgery primarily reserved for patients with heart failure or inadequate response to antibiotic treatment, as recommended by the American College of Cardiology/American Heart Association (ACC/AHA) guidelines (Circulation. 2008 Oct 7;118(15):e523). However, the risk of death can be high even in patients without heart failure due to the risk of systemic embolism, and in these patients, the optimal timing for surgery remains under debate. The EASE randomized trial compared early surgical intervention vs. standard care in 76 patients (mean age 47 years) with left-sided endocarditis, severe valve disease, and vegetation > 10 mm in diameter. The early surgery group had surgery within 48 hours of randomization. The standard care group had treatment based on ACC/AHA guidelines with surgery performed only if urgent complications or symptoms persisted after antibiotic therapy. Patients with major stroke, aortic abscess, or prosthetic valve endocarditis were excluded.

 

The median time to surgery for the early surgery group was 24 hours from randomization. In the standard care group, 69% (27 patients) had urgent surgery during hospitalization at median 6.5 days after randomization, and 3 patients had elective surgery more than 2 weeks after randomization.

 

At 6 weeks follow-up, there were no embolic events in the early surgery group compared to a rate of 21% in the standard care group (p = 0.005, NNT 5) (level 1 [likely reliable] evidence). There were no significant differences in in-hospital mortality (3% vs. 3%). There were no additional embolic events in either group at 6 months follow-up. All-cause mortality was 3% vs. 5% (not significant). The endocarditis recurrence rates were similar between groups (0% vs. 3%, not significant) (N Engl J Med 2012 Jun 28;366(26):2466).

 

For more information, see the Infective endocarditis topic in DynaMed.

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About DynaMed Weekly Update

Prepared by the clinician members of the DynaMed Editorial Team, DynaMed Weekly Update is a compilation of one to five articles selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice.

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CME Information

CREDITS

Physicians:
0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
 
Release Date: July 11, 2012
Expiration Date: July 11, 2013
Estimated Completion Time:
15 minutes
 
There is no fee for this activity.

To Receive Credit 
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

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Learning Objectives

Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.
 
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Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

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AAFPEnduring Material activity, DynaMed Weekly Update, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 7, 2012. Term of approval is for one year from this date with the option of yearly renewal. Each Weekly Update is worth .25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

  

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