2016 The American Association for Thoracic Surgery (AATS) consensus guidelines: surgical treatment of infective endocarditis: executive summary

GB Pettersson, JS Coselli, ST Hussain, B Griffin… - The Journal of thoracic …, 2017 - jtcvs.org
Potential Biases Most studies of IE are affected by selection, survival, and referral bias. They
make it difficult to study the natural history of IE in the general population, because treated
and triaged patients enrich the sample seen at regional high-volume centers. Inferences
drawn from results of treating such selected patients may not be helpful to the primary care
physician, who is left without a clear picture of natural history until conservative treatment
fails or appears futile, and it becomes clear that the patient must be referred. 9-29