(P225) MULTI-DISCIPLINARY CLINICAL ENDOCARDITIS PATHWAY (MENDO): COMMUNITY AS CURE

Background: In Saskatchewan and across Canada, injection drug use-associated infective endocarditis (IDU-IE) admissions are rising steadily. After rigorous local chart audits and review of literature, there is considerable variability in the medical and surgical management of IDU-IE and accessibility of specialist and addictions services.

METHODS AND RESULTS: This pre-intervention/post-intervention cohort study measures the MENDO pathway’s impact on patient outcomes between the retrospective and prospective MENDO cohorts. Enrolment began September 25th, 2023 and will continue for 18 months. Inclusion criteria included all adults (≥17 yrs. old) admitted to the Royal University Hospital with a probable or definite diagnosis of endocarditis (by Modified Duke Criteria) who were referred to the MENDO pathway. The pathway seeks to address identified gaps in care, including early treatment of substance use withdrawal, standardization of care, unbiased specialist consultation, and psychosocial support through dedicated social and peer worker involvement. The MENDO cohort aims to increase local surgical intervention rate by 25% and improve in-hospital and long-term survival rates, compared to the retrospective cohort. In addition to the inter-cohort comparison, the MENDO cohort was also evaluated over time for intracohort comparisons at enrolment, discharge, and 3-month follow-up.

Our retrospective (n=77; 1-Jan-2022 to 31-May-2023) and MENDO (n=35; 25-Sep-2023 to 26-Mar-2024, the cutoff date for interim analysis) cohorts were compared. The surgical intervention rate was 22% higher (15.1% vs. 19.4%, p=ns) and the in-hospital mortality rate was 45% lower (14.3% vs. 26%, p=ns) among the MENDO cohort. At hospital discharge, MENDO patients had higher rates of all specialist consultations, including dentistry (8.5% vs. 35.5%, p=0.0115). Between MENDO enrolment and hospital discharge, we noted lower rates of homelessness (27% vs. 6.9%, p =0.059) achieved through dedicated social and peer worker support.

Conclusion: The MENDO pathway is demonstrating promise in addressing gaps in care for patients admitted to the Royal University Hospital with infective endocarditis. Further adjustments must be made to the pathway to improve adherence to treatment plans, acute care diversion to more supportive care environments, and further increasing surgical intervention rate.