A new study has found that social deprivation can have a major impact on outcomes for patients with infective endocarditis, even in a universal healthcare system like the NHS.
Infective endocarditis is an infection of the inner lining of the heart, most often affecting the valves. It occurs when bacteria or other microorganisms enter the bloodstream and attach to the heart, causing potentially life-threatening damage. Despite advances in diagnosis and treatment, the condition remains associated with high mortality and serious complications.
The research, published in EHJ Quality of Care & Clinical Outcomes, is the first to examine how social deprivation affects this serious heart infection at the patient level in the UK.
The research team, co-led by Dr Samuel Watson, NIHR Cardiology Academic Clinical Fellow and Professor Rafal Dworakowski, Consultant Cardiologist and Honorary Senior Clinical Lecturer, King's College Hospital, set out to see whether patients with infective endocarditis from more socially deprived backgrounds had worse health outcomes, even when treated within a universal-access healthcare system.
Previous studies have shown that social deprivation can lead to worse heart health. Despite this, there is little research on how it influences who gets infective endocarditis, how patients are admitted to hospital, and what their health outcomes are.
To explore this, the team carried out a retrospective study using data from King's College Hospital NHS Foundation Trust, Guy's & St Thomas' NHS Foundation Trust, and Barts Health NHS Trust, working together through the newly formed London Endocarditis Research Network (LERN). The study included over 1,700 patient episodes from December 2013 to March 2023, making it the largest regional registry of infective endocarditis published worldwide and the first study from LERN.
The study found that patients from more socially deprived backgrounds had significantly higher death rates at both 30 days and one year. These patients often had more existing health conditions, higher levels of inflammation, and were more likely to develop right-sided endocarditis. They also had fewer surgical procedures, which may reflect delays in seeking care or other factors affecting treatment decisions.
The type of infection-causing organisms were the same across all patients, suggesting that the differences in outcomes are down to a combination of both biological and social factors. The study also showed that patients from more deprived backgrounds were more likely to be female, from self-reported racial minority groups, and have multiple health conditions.
This study demonstrates the profound effect that social deprivation has on outcomes in infective endocarditis. Our findings highlight the importance of collaborative networks like LERN and the urgent need to address social inequalities in cardiovascular health.
Dr Samuel Watson, NIHR Cardiology Academic Clinical Fellow, School of Cardiovascular and Metabolic Medicine & Sciences.
This study shows that even in a universal healthcare system like the NHS, deep inequalities in care and outcomes still exist. By building the London Endocarditis Research Network (LERN), we've created the foundation for pan-London collaboration that's essential to tackling complex cardiovascular disease and driving real change.
Professor Rafal Dworakowski, Consultant Cardiologist & Honorary Senior Clinical Lecturer, King's College Hospital.
This research highlights that social deprivation has a major and complex effect on health outcomes. It also emphasises the need for long-term studies to identify what causes delays in treatment and to find ways to reduce these health inequalities.
