Public Release: 

Simple reminder can help patients avoid dangerous infection

Beth Israel Deaconess Medical Center

BOSTON - A study led by researchers at Beth Israel Deaconess Medical Center (BIDMC) finds that a simple reminder to their doctors can help patients with valvular heart disease to remember to take antibiotics before having their teeth cleaned or undergoing other procedures that may be associated with subsequent heart infections.

This straightforward step can help prevent the development of bacterial endocarditis, a potentially dangerous infection of the heart's inner lining or valves. The prospective survey study appears in the June 24 on-line rapid access issue of Circulation: Journal of the American Heart Association.

The risk of developing bacterial endocarditis is small but the disease can be life-threatening, according to the study's senior author Warren J. Manning, M.D., Chief of Non-Invasive Cardiac Imaging at BIDMC and Associate Professor of Medicine and Radiology at Harvard Medical School.

"Endocarditis develops when bacteria enters the bloodstream, travels to the heart, and attaches to abnormal heart valves and tissue," he explains. Medical and dental procedures that cause bleeding - such as teeth cleaning - are among the most common causes of the infection. By taking antibiotics, generally one hour prior to dental cleanings, the threat of developing endocarditis is greatly reduced in patients with abnormal heart valves and congenital heart disease.

Heart-valve problems are typically diagnosed by a cardiac ultrasound or echocardiogram. If it is determined that a patient has a problem, current American Heart Association recommendations advise that he or she take antibiotics in advance of dental cleanings. Previous research by Manning had found that patient compliance with these recommendations was inconsistent: Nearly 40 percent of affected individuals were not taking antibiotics as recommended and nearly 30 percent of individuals were taking antibiotics unnecessarily.

In this new study, Manning and his coauthors set out to determine the impact of a specific "reminder" printed at the end of the echocardiogram report, which documented a patient's endocarditis risk. Using a standardized electronic reporting system, the authors evenly divided a group of echocardiograms such that half included the "reminder" and half contained no "reminder."

Of 1,461 eligible outpatients eligible during a six-month period, 969 people responded to a mail survey regarding the antibiotic instructions. Of those respondents, nearly 75 percent of those whose echocardiograms included the notation took their antibiotics in advance. Less than two-thirds of those whose test results did not provide any specific recommendations complied with the instructions. "We interpret these results to suggest that implementation of this low-cost, low-tech intervention will serve to improve overall compliance and potentially reduce the frequency of endocarditis," says Manning.

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Study co-authors include Gregory P. Sanders, M.D., Susan B. Yeon, M.D., and Jason Grunes of Beth Israel Deaconess Medical Center; and Todd B. Seto, M.D., M.P.H., of The Queens Hospital, Honolulu, Hawaii.

Beth Israel Deaconess Medical Center is a major patient care, research and teaching affiliate of Harvard Medical School and a founding member of CareGroup Healthcare System. Beth Israel Deaconess is the third largest recipient of NIH Research funding among independent U.S. teaching hospitals.

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