Background: SPH and VGH are the two largest tertiary care centers in BC’s Lower Mainland. Among those served are the low-SES, high-risk population of Vancouver’s Downtown East Side (DTES). We aim to characterize the changing epidemiology of infective endocarditis (IE) in this population from 1995 and 2014. To date, our database is among the world’s largest. Methods: 1337 cases were identified using ICD9/10 codes. A retrospective chart review was conducted to collect demographic data including HIV status, IVDU, neurologic complications and mortality. The cohort was dichotomized into IVDU and non-IVDU, and first (1995-2005) and second (2006-2014) decades. Data analysis was performed using univariate chi-square and t-tests. Results: Age at presentation has increased in the past decade (45 vs 55,p<0.001). Rates of IVDU and HIV have decreased significantly (50.5% vs 44.3%,p<0.001; 21.8% vs 7.9%,p<0.001, respectively). Neurologic complications were less frequent in non-IVDUs (16.5% vs 28.9%,p<0.01). Mortality was greater in those with neurologic complications (RR=2.6 95%CI:2.1-3.3,p<0.001). Patients with neurologic complications were more likely to undergo cardiac surgery (RR=1.6 95%CI:1.3-2.0,p<0.001). Conclusions: Our findings highlight the changing epidemiology of IE. Some discrepancies between our data and the existing literature may be accounted for by Vancouver’s unique DTES population. Further work characterizing this is ongoing.