2.1. Setting and Study Population

We conducted a prospective observational cohort study for all cases of suspected IE that were referred to the ET at Imperial College Healthcare NHS Trust (ICHNT) from the onset of lockdown in the UK (23 March 2020) until the 8 July 2020. The ICHNT is one of the largest hospital groups in the UK, which comprises three acute hospitals with 1,400 beds and receives referrals from several district general hospitals for specialist cardiology and cardiothoracic services. The ET consists of experienced consultants in infectious diseases, microbiology, cardiology, and cardiothoracic surgery. The ET reviews cases weekly, and a minimum of one consultant from each specialty is present, although frequently there are several from each specialty. Referrals for discussion at the meeting are received electronically from inpatient medical clinical teams. Approval for this project was granted by the Audit Department at Imperial College NHS Healthcare Trust (Reference No. CAR_029).

All cases aged 18 years and above were prospectively included in this observational study. Anonymised data were collected including patient demographics and individually examined for ET meeting outcome, imaging modalities performed, Modified Duke Criteria [4] with and without imaging parameters, and whether there were other clear clinical sources of possible infection, as well as 30-day and 12-month clinical outcomes (all-cause mortality) from the time of discussion.