This paper is available in full as an electronic page in this issue of Heart

摘要

Embolic stroke is one of the most devastating consequences of infective endocarditis. One strategy to avoid embolic strokes uses echocardiography to identify patients who warrant early surgical intervention, as earlier surgery has been associated with lower mortality. In this study the cost-effectiveness of echocardiography as a risk-stratification tool to aid therapeutic decision making was assessed by constructing a decision tree and Markov analysis model using published and institutional data. The models compared surgery for high-risk patients based on clinical factors ("standard care") and surgery for high-risk patients based on echocardiographic findings ("echocardiogra-phyguided"). The results confirmed that echo-guided risk stratification for early surgery in patients with large vegetations is a cost-attractive treatment strategy for infective endocarditis, as it improves outcome for an incremental cost <$50 000/ QALY providing baseline stroke risk was greater than 3.65%.