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assessing and improving symptom management, communication, advanced care planning, as well as psychosocial and spiritual needs.850

14 Sex differences

Female sex is less common in patients diagnosed with IE, being present in approximately one-third of cases; a finding that has been demonstrated in multiple IE patient subpopulations and across different regions.5,59,723,851,852 The reason why female sex is observed less frequently in IE is unknown and deserves further investigation. Possible reasons include underdiagnosis of IE in women, referral bias in published studies, intrinsic protective mechanisms against IE in women, and decreased incidence of risk factors for IE in women (e.g. bicuspid aortic valve disease, previous heart valve replacement surgery), among others. A recent nationwide population study of individual patient-level linkage data of 7513 patients hospitalized for IE in Scotland, however, demonstrated roughly equal proportions of male and female patients throughout the 25-year study period.27

Female patients with IE have been demonstrated to have a higher prevalence of several risk factors for IE in comparison to their male counterparts including older age, mitral valve involvement, S. aureus infection, neurological symptoms, and haemodialysis.853–856 However, men have a higher prevalence of other important risk factors including previous prosthetic valve replacement, periannular complications, CAD, and liver cirrhosis.855 Some studies have demonstrated higher mortality rates for female patients with IE,856 while others have demonstrated no differences in

Family and

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Continuity and transition

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Figure 14 Concept of patient-centred care in infective endocarditis.

ESC Guidelines                                                                                                                                                                                          4011

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