Infective
endocarditis (IE) is a serious mainly bacterial infection associated
with high mortality. Epidemiology of fatal IE is however largely
unknown. We studied occurrence and trends of fatal IE in a
population-based setting.

All adults (≥18 years
of age) who deceased due to IE in Finland during 2004-2016 were studied.
Data was collected from the nationwide, obligatory Cause of Death
Registry. Background population consisted of 28,657,870 person-years and
651,556 deaths.

Infective endocarditis
contributed to death in 754 cases and was the underlying cause of death
in 352 cases. The standardized incidence rate of deaths associated with
IE was 1.42 (95% confidence interval (CI): 1.32-1.52) per 100,000
person-years. Incidence rate increased progressively with aging from
50 years of age. Men had a two-fold risk of acquiring fatal infective
endocarditis compared to women (risk ratio (RR) 1.95; 95% CI: 1.71-2.22;
P < 0.0001). On average, IE contributed to 1.16 (95% CI: 1.08-1.24)
out of 1000 deaths in general adult population. The proportionate amount
of deaths with IE was highest in population aged < 40 years followed
by gradual decrease with aging. Incidence rate and proportion of deaths
caused by IE remained stable during the study period.

Our
study describes for the first time the population-based epidemiology of
fatal IE in adults. Men had a two-fold risk of acquiring fatal IE
compared to women. Although occurrence of fatal IE increased with aging,
the proportion of deaths to which IE contributed was highest in young
adult population.

Cause of death; Epidemiology; Incidence rate; Infective endocarditis