European Journal of Cardio-Thoracic Surgery 0 (2018) 1 LETTER TO THE EDITOR RESPONSE trials . To increase the evidence base and knowledge on the ﬁeld of IE, clini- cians and researchers within a broad ﬁeld of expertise must come together to discuss how the scientiﬁc ﬁeld of IE can be expanded. In that way, large multi- Lauge Østergaard* and Emil Loldrup Fosbøl centre research projects may be initiated where patients from tertiary centres Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, are also included. Such projects are dependent on international expertise and Denmark international collaborations that are carried through. Received 3 May 2018; accepted 4 May 2018 Keywords: Infective endocarditis � Population study REFERENCES  Mori M, Geirsson A. Infective endocarditis: a mixed bag in need for In a letter to the editor, Mori and Geirsson  commented on our recent comprehensive classiﬁcation system. Eur J Cardiothorac Surg 2018; doi: article  and argued for the need for a comprehensive classiﬁcation system 10.1093/ejcts/ezy209. for infective endocarditis (IE). We cannot help but agree on this issue. A  Østergaard L, Oestergaard LB, Lauridsen TK, Dahl A, Chaudry M, deeper understanding of this heterogenous disease may help us increase clin- Gislason G et al. Long-term causes of death in patients with infective ical awareness among speciﬁc subgroups, shed light on the prognosis of the endocarditis who undergo medical therapy only or surgical treatment: a different phenotypes of IE and develop treatment strategies for different IE nationwide population-based study. Eur J Cardiothorac Surg 2018; doi: phenotypes. 10.1093/ejcts/ezy156. Population-based studies have been shown to be a cornerstone in the de-  Olmos C, Vilacosta I, Ferna ´ ndez-Pe ´ rez C, Bernal JL, Ferrera C, Garcı ´a- scription and assessment of IE. Spanish, English and Danish research groups Arribas D et al. The evolving nature of infective endocarditis in Spain: a have shown that assessing IE through administrative registries provide us with population-based study (2003 to 2014). J Am Coll Cardiol 2017;70: unique epidemiological insights into this disease [3–5]. The strength of these 2795–804. studies is the large, unselected study population with a long-term follow-up.  Thornhill MH, Jones S, Prendergast B, Baddour LM, Chambers JB, However, as mentioned by Mori and Geirsson, registry-based studies are lim- Lockhart PB et al. Quantifying infective endocarditis risk in patients with ited by the lack of a detailed description of different phenotypes of IE. The predisposing cardiac conditions. Eur Heart J 2018;39:586–95. readers of such studies must be aware of the limitations of registry-based ob-  Østergaard L, Valeur N, Ihlemann N, Bundgaard H, Gislason G, Torp- servational studies so that reasonable conclusions can be drawn from such Pedersen C et al. Incidence of infective endocarditis among patients studies. considered at high risk. Eur Heart J 2018;39:623–9. From our point of view, clinical registries, such as the International Collaboration  Østergaard L, Valeur N, Bundgaard H, Butt JH, Ihlemann N, Køber L et al. on Endocarditis and the European Infective Endocarditis Registry, go hand in hand Temporal changes in infective endocarditis guidelines during the last 12 with nationwide administrative registries. Data sharing and cross-linkage of such years: high-level evidence needed. Am Heart J 2017;193:70–5. registries will overcome some of the drawbacks of the clinical registries and supple- ment the administrative registries with vital clinical data. Such collaborations could be the foundation for a comprehensive classiﬁcation system of IE. However, one *Corresponding author. Department of Cardiology, The Heart Center, must be aware that the clinical registries may be limited by selection bias, where Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark. Tel: +45-41132400; patients from tertiary centres are over-represented and loss to follow-up is a major e-mail: email@example.com (L. Østergaard). concern. In general, the evidence base of guideline recommendations on IE is doi:10.1093/ejcts/ezy210 low, and few recommendations have been based on randomized controlled The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. Downloaded from https://academic.oup.com/ejcts/advance-article-abstract/doi/10.1093/ejcts/ezy210/5017345 by Ed 'DeepDyve' Gillespie user on 12 July 2018 LETTER TO THE EDITOR
European Journal of Cardio-Thoracic Surgery – Oxford University Press
Published: May 28, 2018
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