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Extended Methods. Table S1. Summary of studies of endocarditis incidence or features using electronic health record data or microbiological data, source of information, codes used, methods of deduplication and comparisons of codes and cases. Table S2. Summary of endocarditis codes used in the above studies. Table S3. Secondary/supplementary organism codes used and reviewed. Figure S1. Clinical reviews in the Leeds Endocarditis Service database, Duke status and diagnostic codes. Figure S2. Admissions with an endocarditis diagnosis code and selection for review: Oxford. Figure S3. Review of electronic prescription data in Oxford 2016 with matching to coded data. Table S4. Reviews and Duke status in the Leeds Service Database and matching to endocarditis-coded admissions. Table S5. Agreement between different combinations of endocarditis-coded admissions and confirmed clinical cases in Oxford. Figure S4. Sensitivity/specificity and positive predictive values for different algorithms to identify Duke definite/ possible endocarditis cases from diagnostic codes in Leeds and Oxford. Figure S5. Estimated endocarditis incidence in Oxford based on diagnostic coding and administrative information. Figure S6. Estimated endocarditis cases and causative organism from diagnostic codes compared to clinician cases, Leeds. Figure S7. Estimated endocarditis cases and causative organism from diagnostic codes and microbiological cultures, Oxford. Table S6. Coded organism vs clinician-recorded organism in Leeds Duke definite/possible cases. Table S7. Coded organism vs microbiology blood culture organism in all admissions with a non-I38 endocarditis code in Oxford. Figure S8. Coding depth and use of secondary/supplementary organism codes in Leeds and Oxford. (DOCX 2110 kb)

Supplementary tables. All supplementary tables to accompany the manuscript. Table S1. Diagnosis (ICD-10) and procedure (OPCS-4) codes identifying high-risk individuals with pre-existing prosthetic valve or congenital heart disease. Table S2. Secondary ICD-10 codes for potential causal organisms. Table S3. Classification of SGSS organisms into subgroups. Table S4. Results of an interrupted time-series analysis testing for a difference in trend before and after a fixed date, for each month in the study period using Poisson regression, for Criteria A. (PDF 753 kb)

Supplementary figures. All supplementary figures to accompany the manuscript. Figure S1. Effect of applying different methods to adjust for changes in population, for all 3 criteria. Figure S2. Monthly cases of infective endocarditis excluding individuals identified as high-risk or as illicit drug users. Figure S3. Causative organism based on secondary diagnosis codes in HES, for all 3 criteria. Figure S4. Of infective endocarditis cases with an organism code present in HES, proportion that were coded as streptococcal, staphylococcal, or other/unnamed (including mixtures), for all 3 criteria. Figure S5. Of infective endocarditis cases with an organism code present in HES, proportion that were coded exclusively as streptococcal, staphylococcal or other/unnamed, or else with a mixture of codes, for all 3 criteria. Figure S6. Causative organism based on SGSS: monthly agreement of SGSS organism compared to HES organism code, based on 3 groups: streptococcal, staphylococcal, other/unnamed, for all 3 criteria. Figure S7. Of all infective endocarditis cases that were matched to an organism in SGSS, proportion that were classed as oral streptococci, for all 3 criteria. Figure S8. Infective endocarditis cases that were matched to an organism in SGSS. The HACEK group consists of Haemophilus species, Aggregatibacter (previously Actinobacillus), Cardiobacterium, Eikenella, Kingella. CONS – Coagulase negative staphylococci. (PDF 231 kb)

Supplementary tables. All supplementary tables to accompany the manuscript. Table S1. Diagnosis (ICD-10) and procedure (OPCS-4) codes identifying high-risk individuals with pre-existing prosthetic valve or congenital heart disease. Table S2. Secondary ICD-10 codes for potential causal organisms. Table S3. Classification of SGSS organisms into subgroups. Table S4. Results of an interrupted time-series analysis testing for a difference in trend before and after a fixed date, for each month in the study period using Poisson regression, for Criteria A. (PDF 753 kb)

Supplementary figures. All supplementary figures to accompany the manuscript. Figure S1. Effect of applying different methods to adjust for changes in population, for all 3 criteria. Figure S2. Monthly cases of infective endocarditis excluding individuals identified as high-risk or as illicit drug users. Figure S3. Causative organism based on secondary diagnosis codes in HES, for all 3 criteria. Figure S4. Of infective endocarditis cases with an organism code present in HES, proportion that were coded as streptococcal, staphylococcal, or other/unnamed (including mixtures), for all 3 criteria. Figure S5. Of infective endocarditis cases with an organism code present in HES, proportion that were coded exclusively as streptococcal, staphylococcal or other/unnamed, or else with a mixture of codes, for all 3 criteria. Figure S6. Causative organism based on SGSS: monthly agreement of SGSS organism compared to HES organism code, based on 3 groups: streptococcal, staphylococcal, other/unnamed, for all 3 criteria. Figure S7. Of all infective endocarditis cases that were matched to an organism in SGSS, proportion that were classed as oral streptococci, for all 3 criteria. Figure S8. Infective endocarditis cases that were matched to an organism in SGSS. The HACEK group consists of Haemophilus species, Aggregatibacter (previously Actinobacillus), Cardiobacterium, Eikenella, Kingella. CONS – Coagulase negative staphylococci. (PDF 231 kb)