Heart failure (HF) is the most common complication of infective endocarditis, responsible for high rates of mortality.

Our aim were to determine the clinical, echocardiographic, and microbiological variables associated with HF in patients with infective endocarditis and in-hospital mortality and association of surgery with outcome.

A retrospective analysis of confirmed cases of infective endocarditis (IE), according to Duke criteria, admitted to a Moroccan tertiary hospital between December 2013 and September 2019. The main outcome measures in-hospital mortality.

Of 114 patients with infective endocarditis enrolled, 70 (61%) had heart failure, and 44 (62%) were classified as having New York Heart Association class III or IV symptom status. Within the subset with HF, 52 (74%) underwent valvular surgery during the index hospitalization.

In-hospital mortality was 21.4% for the entire HF cohort, with lower mortality observed in patients undergoing valvular surgery compared with medical therapy alone (13.4% vs. 44.4%, respectively; P<0.05). Study of independent factors in this population showed that advanced age, health care-associated infection, causative microorganism (Staphylococcus aureus or fungi), severe HF (New York Heart Association class III or IV) at admission, stroke, and prosthetic valves were associated with in-hospital mortality, whereas valvular surgery within first four-weeks after hospitalization was associated with lower mortality.

In this cohort of patients with infective endocarditis complicated by HF, severity of HF was strongly associated with surgical therapy and subsequent mortality, whereas valvular surgery was associated with lower in-hospital mortality.