Aims The EURO-ENDO registry aimed to study the management and outcomes of patients with infective endocarditis (IE). Methods and results Prospective cohort of 3116 adult patients (2470 from Europe, 646 from non-ESC countries), admitted to 156 hospitals in 40 countries between January 2016 and March 2018 with a diagnosis of IE based on ESC 2015 diagnostic criteria. Clinical, biological, microbiological, and imaging [echocardiography, computed tomography (CT) scan, F-18-fluorodeoxyglucose positron emission tomography/computed tomography (F-18-FDG PET/CT)] data were collected. Infective endocarditis was native (NVE) in 1764 (56.6%) patients, prosthetic (PVIE) in 939 (30.1%), and device-related (CDRIE) in 308 (9.9%). Infective endocarditis was community-acquired in 2046 (65.66%) patients. Microorganisms involved were staphylococci in 1085 (44.1%) patients, oral streptococci in 304 (12.3%), enterococci in 390 (15.8%), and Streptococcus gallolyticus in 162 (6.6%). F-18-fluorodeoxyglucose positron emission tomography/computed tomography was performed in 518 (16.6%) patients and presented with cardiac uptake (major criterion) in 222 (42.9%) patients, with a better sensitivity in PVIE (66.8%) than in NVE (28.0%) and CDRIE (16.3%). Embolic events occurred in 20.6% of patients, and were significantly associated with tricuspid or pulmonary IE, presence of a vegetation and Staphylococcus aureus IE. According to ESC guidelines, cardiac surgery was indicated in 2160 (69.3%) patients, but finally performed in only 1596 (73.9%) of them. In-hospital death occurred in 532 (17.1%) patients and was more frequent in PVIE. Independent predictors of mortality were Charlson index, creatinine > 2 mg/dL, congestive heart failure, vegetation length > 10 mm, cerebral complications, abscess, and failure to undertake surgery when indicated. Conclusion Infective endocarditis is still a life-threatening disease with frequent lethal outcome despite profound changes in its clinical, microbiological, imaging, and therapeutic profiles.

Aims The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) European Endocarditis (EURO-ENDO) registry aims to study the care and outcomes of patients diagnosed with infective endocarditis (IE) and compare findings with recommendations from the 2015 ESC Clinical Practice Guidelines for the management of IE and data from the 2001 Euro Heart Survey. Methods and results Patients (n = 3116) aged over 18 years with a diagnosis of IE based on the ESC 2015 IE diagnostic criteria were prospectively identified between 1 January 2016 and 31 March 2018. Individual patient data were collected across 156 centres and 40 countries. The primary endpoint is all-cause mortality in hospital and at 1 year. Secondary endpoints are 1-year morbidity (all-cause hospitalization, any cardiac surgery, and IE relapse), the clinical, epidemiological, microbiological, and therapeutic characteristics of patients, the number and timing of non-invasive imaging techniques, and adherence to recommendations as stated in the 2015 ESC Clinical Practice Guidelines for the management of IE. Conclusion EURO-ENDO is an international registry of care and outcomes of patients hospitalized with IE which will provide insights into the contemporary profile and management of patients with this challenging disease.

was obtained from the Prescription Cost Analysis system, which holds information on every prescription dispensed in the community in England, covering a population of more than 50 million people.We obtained data for all anti-platelet agents, statins, beta-blockers and ACEi/ARBs from 1998 to 2015.Results: There has been an increase in the prescription of all drugs aimed at preventing CVD over the 17 year study period except for anti-platelet agents (see Figure1).The number of prescriptions for antiplatelet agents increased linearly from 1998 to 2009 after which this number plateaued and has remained at a similar level for the subsequent 6 years.Figure 1 Conclusion: Prescriptions for drugs to reduce the risk of CVD have continually increased from 1998 to 2015 except for antiplatelet agents which plateaued in 2009.The timing of this reduction in anti-platelet prescribing coincides with the publication of two meta-analyses and a large randomised controlled trial that cast doubt on the efficacy of aspirin in primary prevention and raised concerns about the increased risk of bleeding in this population.Nonetheless, CVD prevention still remains a major challenge for the general population.

Purpose: Multifocal atrial rhythms (MARs), namely multifocal atrial tachycardia and chaotic atrial rhythm, are rare arrhythmias mostly seen in hospitalized patients with several comorbidities to who they imply high in-hospital mortality. We have examined the prevalence of MARs and the associated characteristics in outpatient elderly subjects from Ikaria study. Methods: In this cohort study we included 175 subjects aged 85±7 years (range 75-103). Demographic and clinical characteristics were recorded in all participants. All individuals underwent a thorough echocardiographic examination. ECG was recorded from a 12-lead surface digital recorder and diagnosis was performed by two independent and blinded to the study physicians. The diagnosis of MARs was based on the identification of at least three different P waves contours on the surface ECG, with irregular P-P intervals, and an isoelectric baseline between the P waves. Results: Sinus rhythm was present in 73% of the subjects, atrial fibrillation in 14%, MAR in 7%, paced rhythm in 4% and atrial flutter in 1%. Subjects with MARs as compared to those without were older (92±4 years vs. 85±7, p=0.001) while there was no difference in body mass index (BMI) (26.67±4.71 kgm/m2 vs. 26.94±3.77, p=0.82), creatinine clearance (41.39±13.48 ml/min vs. 50.46±17.08, p=0.14), male gender (33% vs. 51%, p=0.22), serum K+ levels (4.6±0.5 mEq/L vs. 4.6±0.6, p=0.93), smoking habits (8.3% vs. 13.9%, p=0.58), EF (56±5% vs. 57±6%, p=0.74), left atrial volume (48±17 ml vs. 60±26, p=0.16), physical activity status (58% vs. 62%, p=0.87), use of b-blockers (17% vs. 13%, p=0.72), digitalis use (10% vs. 8%, p=0.78) and in the presence of arterial hypertension (AH) (83% vs. 84%, p=0.96), diabetes mellitus (DM) (25% vs. 30%, p=0.72), history of cardiovascular disease (CVD) (18% vs. 20%, p=0.86) and chronic obstructive pulmonary disease (COPD) (38% vs. 16%, p=0.11), Binary logistic regression analysis after adjustment for confounders such as gender, EF, left atrial volume, COPD and creatinine clearance revealed age as the only significant predictor of MARs (OR=1.22, 95% CI: 1.01 to 1.47, p=0.04). For each year increase in age, the prevalence of MARs was raised in average by 22%, independently of other known confounders. Conclusion: In this cohort of oldest old individuals we have documented a high prevalence of MARs which was associated exclusively with increased age. These findings imply the possibility that MARs constitute a common arrhythmia in very old subjects, which prognostic impact needs further investigation in prospective studies