One of the approaches of studying diseases is how they evolve over time in different scenarios. Time may refer to years, decades, even centuries; scenarios may refer to different geographic peculiarities, epidemiological conditions, clinical and surgical therapeutic medical facilities available, access to proper health care, access to the diagnosis, and access to the treatment.

Infective endocarditis has been subject to this approach over time after the description of the disease in seventheenth century.¹ Among the historical outstanding contributions were the three famous Gulstonian Lectures delivered by William Osler.² As a rare disease, incidence of infective endocarditis was estimated to be between 3 and 10 episodes per 100,000 person-years in different surveys.³ Decades ago, institutional reports of large series of patients over time were traditional in the literature.^4-6 Some of these series were published before the advent of large epidemiological studies that were feasible due to new technologies related to data science and data analyses. More recent reports have studied the changing nature of the disease over time: in France,⁷ in an American county,⁸ in England,⁹ in Italy,¹⁰ in Europe,³ in an international collaboration,¹¹ and in one Brazilian institution over a four-decade period.¹²

In this issue of the journal,¹³ the authors report on an epidemiological analysis of mortality of patients with the diagnosis of infective endocarditis over a 27-year period in Brazil (1996-2023), by means of an exploratory retrospective and descriptive approach with secondary data retrieved from the Mortality Information System (SIM) and made available in the Unified Health System's website (DATASUS). The data available included that up to 2023. Cases were retrieved by listing selected ICD-10 codes (I33, I38). Potentially related codes, such as I33.9 or B37.6, were not included in the analyses. Thus, sub-representation of diagnosis due to the retrieval system may have occurred.

The highest number of deaths occurred in 2023, with 2,279 cases (5.68%), while the lowest prevalence occurred in 1996, with 689 cases (1.72%). There was a high discrepancy in frequencies according to the region of the country, which proved to be highest in Southeast. The findings have demonstrated regional disparities and sex differences. Such disparities may be related to different population densities, either in rural areas or urban areas; an epidemiological environment; access to healthcare facilities for diagnoses and treatment; as well as access to resources for diagnosis and therapy in the different regions of the country. In conclusion, the study adds to epidemiologic research in the field and may be of help for additional studies and interventions.