Infective endocarditis: five-year epidemiological and clinical report (2021-2025). the POL-ENDO substudy

Background

Contemporary European registries, including the EURO-ENDO, have demonstrated evolving epidemiological patterns, increasing comorbidity burden, and persistent mortality. In Poland, nationwide data have been limited to preliminary 12-month observations from the POL-ENDO registry, which suggested substantial differences compared with European cohorts, including higher comorbidity rates, underutilization of cardiac surgery, and higher mortality. Comprehensive nationwide analyses with year-to-year trend assessment have been lacking.

Aims

To characterize the epidemiological and clinical profile of patients with IE in Poland and to assess year-to-year temporal trends in patient characteristics, diagnostic strategies and outcomes using nationwide POL-ENDO registry data.

Methods

A prospective multicenter observational cohort study in IE patients from 183 medical centers in Poland registered between August 2021 and January 2026 was conducted.

Results

The analysis included 2746 patients with IE. Over time, the proportion of male patients increased significantly (p<0.001), while mean age remained stable, exceeding that reported in European cohorts. Cardiovascular comorbidities remained largely stable, except for a significant rise in HF (p=0.002) and hypertension (p=0.022), further widening differences compared with EURO-ENDO data. An increasing incidence of PVIE (p=0.002), particularly involving bioprosthesis (p=0.019), was observed, alongside a decline in tricuspid valve involvement (p=0.024). Etiological distribution remained stable. CT utilization rose (p=0.017), whereas adoption of other advanced imaging modalities (MRI, PET, SPECT) did not change. No significant temporal reduction in in-hospital complications was observed. HF, as in hospital complication, remained more than twice as frequent as in European cohorts. Importantly, no significant improvement was found in surgical intervention rates (p=0.345), in-hospital mortality (p=0.221), 1-month mortality (p=0.437), or 6-month mortality (p=0.183).

Conclusion

This five-year nationwide analysis confirms a progressively increasing comorbidity burden among Polish patients with IE . Predominance of males among IE patients is increasing. A significant rise in HF and hypertension was observed over five years. Increasing of the prosthetic valve IE was observed. Etiological distribution remained stable. CT is more commonly used over the years. Adoption of other advanced imaging modalities (MRI, PET, SPECT) is not increasing. HF remained as inhospital complications more than twice as frequent as in European cohorts. No significant improvement was found in surgical intervention rates. No significant temporal reduction in in-hospital mortality was observed.

The findings highlight suboptimal implementation of ESC guideline-recommended multimodality imaging and surgical strategies and underscore the urgent need for systemic changes to improve outcomes in Polish patients with IE