Infective endocarditis in older adults

Age is a strong risk factor for infective endocarditis (IE). The annual incidence of IE is 145 cases per million in patients aged 70–80 years. Older adults are more commonly affected by IE, in part because of the increasing number of invasive procedures and intracardiac devices implanted in these patients. Diagnosis of IE is frequently delayed in this population due to atypical clinical presentations and difficulty interpreting echocardiographic findings. Additionally, older adults have a wider spectrum of causative microbiology compared to younger adults. Due to insidious initial symptoms, delayed diagnosis, multimorbidity, and a higher incidence of aggressive pathogens, IE in older adults is associated with a poor prognosis and high rate of complications. Unfortunately, the management of IE in this population has been sparsely investigated, and international guidelines currently do not incorporate adapting the therapeutic strategy to the patient&s;s functional status, comorbidities, and goals of care. As this disease is uncommon but potentially deadly, management in the older adult should involve deliberation by a multidisciplinary team and should align with the individual&s;s goals of care.