Low-Cost Reminder Helps Prevent Infections for Heart Patients

Helping doctors remind their patients with valvular heart disease to take antibiotics before dental procedures can help prevent bacterial endocarditis, according to a report in today's rapid access issue of Circulation: Journal of the American Heart Association.

Bacterial endocarditis is an infection in the heart's inner lining or heart valves. It's caused by bacteria in the bloodstream. Most prone to the infection are people with valvular heart disease, which includes congenital heart disease, mitral valve prolapse and artificial heart valves. Taking antibiotics before procedures likely to cause bleeding -- such as dental cleaning -- can often prevent infection.

"One problem is that not all physicians know an individual patient's risk for endocarditis. A second issue is that many do not advise their patients about the risk. We are looking at easily implemented solutions to improve compliance with current American Heart Association recommendations," says study senior author Warren J. Manning, M.D., of the cardiovascular division, Beth Israel Deaconess Medical Center and Harvard Medical School.

An ultrasound of the heart, called an echocardiogram, shows the heart chambers and how they function. It can rapidly reveal heart valve abnormalities. The American Heart Association recommends that people with valvular abnormalities take preventive antibiotics depending on their infection risk.

One way to remind doctors to access and discuss infection risk with their patients is by printing the infection risk and stating whether antibiotics are indicated on the echocardiogram report physicians receive.

For the study, comment about infection risk and the need for antibiotics were included on about half of the echocardiogram reports from almost 1,500 patients. Researchers then surveyed patients to find out who had received instructions on antibiotics from their physicians. Of the nearly 1,000 responses, 73 percent of patients whose echocardiagrams included comments were given appropriate antibiotic instructions compared to 65 percent whose reports excluded comment.

The researchers conclude that including an echocardiographic report statement about endocarditis risk and the need for preventive antibiotics is a simple, low-cost intervention that improves compliance with American Heart Association recommendations.