{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:46:50Z","timestamp":1785732410448,"version":"3.56.0"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Guidelines recommend prompt diagnosis and timely surgical intervention for infective endocarditis (IE); however, adherence in clinical practice remains inconsistent. We quantified delays throughout the IE care pathway and evaluated their association with mortality after adjusting for baseline severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a retrospective single-centre cohort study of consecutive patients with definite IE and a guideline-based surgical indication who were admitted to Misericordia Hospital, Grosseto (Italy), between 1 January 1998 and 31 December 2023. Time intervals from the first symptom to hospital admission, to transthoracic (TTE), transoesophageal (TOE) echocardiography, and surgery were recorded. Patients were classified as In-Time if surgery was performed within the guideline-recommended timeframe (emergency: &amp;lt;24\u2005h; urgent: &amp;lt;5 days; elective: otherwise) or Delayed. A prespecified subgroup analysis within the Delayed group distinguished Delayed-operated from Delayed-never-operated patients. Univariable and multivariable logistic regression estimated the association between delay and in-hospital mortality, adjusting for age, Sequential Organ Failure Assessment (SOFA) score,\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      aetiology, acute heart failure, embolization, and abscess.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The analytic cohort comprised 198 patients with a surgical indication: 62 (31.3%) in the In-Time group and 136 (68.7%) in the Delayed group (78 Delayed-operated and 58 Delayed-never-operated). The interval from symptom onset to hospital admission was the largest single contributor to the total time to surgery (\u223c50% of the total). Crude in-hospital mortality was 9.7% in the In-Time group and 40.4% in the Delayed group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Within the Delayed group, in-hospital mortality was 20.5% in Delayed-operated patients and 67.2% in Delayed-never-operated patients. In the multivariable model (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009193, events\u2009=\u200960), delayed treatment remained independently associated with in-hospital mortality [adjusted OR 3.37, 95% confidence interval (CI) 1.19\u20139.56;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009= 0.022]; SOFA score [adjusted odds ratio (aOR) 1.43 per point, 1.23\u20131.66;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001] and the presence of any embolization (aOR 2.42, 1.09\u20135.38;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009= 0.030) were also independently significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Delays are common along the IE care pathway and concentrated in the pre-admission and indication-to-surgery phases. Patients with delayed management have substantially higher crude and adjusted in-hospital mortality, with the worst outcomes in patients who never reach the operating room. These observations support modifiable system-level priorities: educating general practitioners and high-risk patients about suspicious symptoms; faster in-hospital access to TOE and PET\/CT; and implementing a structured endocarditis Heart Team with protected operating slots.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1847517","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:26:34Z","timestamp":1785731194000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Avoidable delays in the care of infective endocarditis patients: a priority issue"],"prefix":"10.3389","volume":"13","author":[{"given":"Pasquale","family":"Baratta","sequence":"first","affiliation":[{"name":"Cardiology Department, Misericordia Hospital","place":["Grosseto, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Cresti","sequence":"additional","affiliation":[{"name":"Cardiology Department, Misericordia Hospital","place":["Grosseto, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"De Sensi","sequence":"additional","affiliation":[{"name":"Cardiology Department, Misericordia Hospital","place":["Grosseto, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Sposato","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Misericordia Hospital","place":["Grosseto, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Picchi","sequence":"additional","affiliation":[{"name":"Cardiology Department, Misericordia Hospital","place":["Grosseto, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugo","family":"Limbruno","sequence":"additional","affiliation":[{"name":"Cardiology Department, Misericordia Hospital","place":["Grosseto, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3948","DOI":"10.1093\/eurheartj\/ehad193","article-title":"2023 ESC guidelines for the management of endocarditis","volume":"44","author":"Delgado","year":"2023","journal-title":"Eur Heart J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"3222","DOI":"10.1093\/eurheartj\/ehz620","article-title":"Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO registry: a prospective cohort study","volume":"40","author":"Habib","year":"2019","journal-title":"Eur Heart J"},{"key":"B3","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1001\/jama.2018.7596","article-title":"Management considerations in infective endocarditis: a review","volume":"320","author":"Wang","year":"2018","journal-title":"J Am Med Assoc"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e72","DOI":"10.1161\/CIR.0000000000000923","article-title":"2020 ACC\/AHA guideline for the management of patients with valvular heart disease","volume":"143","author":"Otto","year":"2021","journal-title":"Circulation"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2466","DOI":"10.1056\/NEJMoa1112843","article-title":"Early surgery versus conventional treatment for infective endocarditis","volume":"366","author":"Kang","year":"2012","journal-title":"N Engl J Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1253","DOI":"10.1002\/ejhf.2525","article-title":"Characteristics, management, and outcomes of patients with left-sided infective endocarditis complicated by heart failure: a substudy of the ESC-EORP EURO-ENDO registry","volume":"24","author":"Bohbot","year":"2022","journal-title":"Eur J Heart Fail"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1626","DOI":"10.21037\/atm-20-3880","article-title":"A narrative review of early surgery versus conventional treatment for infective endocarditis: do we have an answer?","volume":"8","author":"Benedetto","year":"2020","journal-title":"Ann Transl Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1007\/s10459-022-10194-8","article-title":"Identifying and prioritizing educational content from a malpractice claims database for clinical reasoning education in the vocational training of general practitioners","volume":"28","author":"van Sassen","year":"2023","journal-title":"Adv Health Sci Educ Theory Pract"},{"key":"B9","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1007\/s12350-018-1434-1","article-title":"Optimizing the diagnostic workup of infective endocarditis: an urgent need for studies focused on defining the decision-making process","volume":"27","author":"Pizzi","year":"2020","journal-title":"J Nucl Cardiol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1080\/00365540902984701","article-title":"Infective endocarditis-related stroke: diagnostic delay and prognostic factors","volume":"41","author":"Epaulard","year":"2009","journal-title":"Scand J Infect Dis"},{"key":"B11","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1086\/313753","article-title":"Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis","volume":"30","author":"Li","year":"2000","journal-title":"Clin Infect Dis"},{"key":"B12","first-page":"826","article-title":"Infectious endocarditis: reasons for a delayed diagnosis","volume":"121","author":"Misteli","year":"1991","journal-title":"Schweiz Med Wochenschr"},{"key":"B13","doi-asserted-by":"publisher","first-page":"95","DOI":"10.4103\/jcecho.jcecho_28_19","article-title":"Normal values of the mitral-aortic intervalvular fibrosa thickness: a multimodality study","volume":"29","author":"Cresti","year":"2019","journal-title":"J Cardiovasc Echogr"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e024401","DOI":"10.1161\/JAHA.121.024401","article-title":"Surgical timing in patients with infective endocarditis and with intracranial hemorrhage: a systematic review and meta-analysis","volume":"11","author":"Musleh","year":"2022","journal-title":"J Am Heart Assoc"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1847517\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:26:34Z","timestamp":1785731194000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1847517\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,3]]},"references-count":14,"alternative-id":["10.3389\/fcvm.2026.1847517"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1847517","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,3]]},"article-number":"1847517"}}