Infective endocarditis (IE) is a complex and often misunderstood disease, carrying a substantial burden of morbidity and mortality. Over the past two decades, its incidence has risen steadily, accompanied by a growing predominance of highly virulent pathogens. Despite substantial advances in diagnostic tools, surgical techniques and perioperative management, IE continues to present major clinical challenges. In-hospital mortality remains extremely high, ranging from 15 to 30%, with a one-year mortality exceeding 40% in specific patient groups. In addition to its clinical impact, IE imposes a substantial economic burden, primarily due to prolonged hospitalization, extensive diagnostic work-ups, complex surgical interventions and long-term antibiotic therapy and follow-up. In such a complex scenario, delays in diagnosis and treatment are unfortunately common, often leading to fragmented and inefficient healthcare pathways, resulting in suboptimal patient management and compromised clinical outcomes. In response to these challenges, a dedicated Clinical Pathway (CP) for IE patients has been implemented to enhance interdisciplinary collaboration and ultimately improve patient outcomes.

Background: According to current guidelines, patients with heart valve disease should be followed by Heart Valve Clinics (HVCs). Regular quality analysis is a major prerequisite of an HVC’s program, but few data have been reported so far. Methods: We retrospectively collected patients with isolated, native aortic valve stenosis who had been visited in our HVC at least once between 2021 and 2024. For each outpatient visit, symptoms, physical examination, echocardiographic data, complementary tests, and indications were acquired. Also, adverse events (hospitalization, unplanned procedures, and death) were retrieved. Results: A total of 320 patients were included. Mean visits/patient ratio was 1.2. At the first visit, 69.7% already had severe aortic stenosis, and severe symptoms (NYHA ≥ III) were evident in 24.4%. In addition, 26.5%, 59.1%, 12.8%, and 1.6% were in Généreux stage I, II, III, and IV, respectively. Overall, 197 (78.5%) and 54 (21.5%) patients received an indication for transcatheter AVR and surgical AVR, respectively. AVR-free survival was 46%, 23%, and 6% at 6, 12, and 24 months, respectively (mean 8.8 months CI95% 7.7–9.9). Adverse event-free survival was 97.2%, 95.5%, and 85% at 3, 6, and 12 months, respectively. Conclusions: Patients referred to our HVC already had an advanced disease with cardiac damage. Transcatheter AVR was mostly indicated, and it showed excellent short-term results. A low rate of adverse events was seen among patients in follow-up, but the odds of receiving AVR were high and driven by Généreux’s stage. Despite these favorable results, further efforts to sensitize earlier patient referral should be made.