In the Journals

Opioid epidemic contributes to annual rise in infective endocarditis

All regions of the U.S. are experiencing greater incidence of infective endocarditis attributed to the national opioid epidemic, with young, lower-income, white men being the most affected, according to a study published in the Journal of the American Heart Association.

The overall prevalence of drug abuse-related infective endocarditis (DA-IE) almost doubled between 2002 and 2016 (2002, 48 per 10,000 people; 2016, 79 per 10,000 people), with the highest annual percent change being in the Midwest (4.9%), researchers reported.

Moreover, compared with non-drug abusers who had infective endocarditis, patients with DA-IE were younger (median age, 38 years vs. 70 years; P < .001), more likely to be men (55.5% vs. 50.8%; P < .001), more likely to be on Medicaid (45.1% vs. 8.9%; P < .001) and more likely to be in the lowest quartile range of median household income (42.4% vs. 30.7%; P < .001). In addition, this group was also more likely to present with comorbidities including hepatitis C (8.2% vs. 1.2%; P < .001), liver disease (18.6% vs. 4.9%; P < .001), HIV (6% vs 1.2%; P < .001) and alcohol abuse (13.6% vs 3.0%; P < .001), according to the researchers.

Alarming findings
“Geographically, we found that drug abuse infective endocarditis is increasing across all regions of the U.S., with the Midwest having the highest annual percent increase,” Serge C. Harb, MD, assistant professor of medicine at Cleveland Clinic Lerner College of Medicine, and colleagues wrote. “We believe these findings are alarming from a public health standpoint and outline the need for an immediate tailored action plan.”

In other findings, patients with DA-IE underwent either cardiac or valve surgery more often (7.8% vs. 6.2% and 7.1% vs. 5.1%, respectively; P < .001) in addition to having higher median length of stay (9 days vs. 7 days; P < .001) and higher hospitalization costs ($52,744 vs. $37,373, P < .001). According to the study, the DA-IE group did, however, have lower inpatient mortality (6.4% vs 9.1%; P < .001).

Complex care
“The care for patients with DA-IE is very complex and we agree with the American Association of Thoracic Surgery guidelines that it involves a ‘specialized endocarditis team,’ including cardiology, cardiac surgery, infectious disease, neurologist, nephrologist, addiction specialists, case management and nursing,” the authors wrote. “Unfortunately, treatment for opioid addiction after hospitalization is low. The two most common reasons for this are that patients were not ready to stop using illicit drugs or they did not have health care coverage to afford appropriate treatment. The care of patients with DA-IE after discharge should include follow-up with drug rehabilitation.”

In this retrospective cohort study using data from the NIS database, researchers analyzed the hospitalizations that occurred between 2002 and 2016 of patients with a primary or secondary diagnosis of IE (median age, 68 years; 51% men; 72% white; 50.9% with hypertension; 26.9% with diabetes; 12.4% on Medicaid). A total of 954,709 hospitalizations were included, with 9.9% of patients having drug abuse.

“Further research is needed on a geographic level to identify clusters or ‘hot zones’ of DA-IE outbreaks such as in rural areas where opioids are more likely to be abused,” the authors wrote. “Lastly, we show the need for resource allocations and public health interventions to target the young, poor, Caucasian population, most at risk at a national level.” – by Scott Buzby

Disclosures: The authors report no relevant financial disclosures.

All regions of the U.S. are experiencing greater incidence of infective endocarditis attributed to the national opioid epidemic, with young, lower-income, white men being the most affected, according to a study published in the Journal of the American Heart Association.

The overall prevalence of drug abuse-related infective endocarditis (DA-IE) almost doubled between 2002 and 2016 (2002, 48 per 10,000 people; 2016, 79 per 10,000 people), with the highest annual percent change being in the Midwest (4.9%), researchers reported.

Moreover, compared with non-drug abusers who had infective endocarditis, patients with DA-IE were younger (median age, 38 years vs. 70 years; P < .001), more likely to be men (55.5% vs. 50.8%; P < .001), more likely to be on Medicaid (45.1% vs. 8.9%; P < .001) and more likely to be in the lowest quartile range of median household income (42.4% vs. 30.7%; P < .001). In addition, this group was also more likely to present with comorbidities including hepatitis C (8.2% vs. 1.2%; P < .001), liver disease (18.6% vs. 4.9%; P < .001), HIV (6% vs 1.2%; P < .001) and alcohol abuse (13.6% vs 3.0%; P < .001), according to the researchers.

Alarming findings
“Geographically, we found that drug abuse infective endocarditis is increasing across all regions of the U.S., with the Midwest having the highest annual percent increase,” Serge C. Harb, MD, assistant professor of medicine at Cleveland Clinic Lerner College of Medicine, and colleagues wrote. “We believe these findings are alarming from a public health standpoint and outline the need for an immediate tailored action plan.”

In other findings, patients with DA-IE underwent either cardiac or valve surgery more often (7.8% vs. 6.2% and 7.1% vs. 5.1%, respectively; P < .001) in addition to having higher median length of stay (9 days vs. 7 days; P < .001) and higher hospitalization costs ($52,744 vs. $37,373, P < .001). According to the study, the DA-IE group did, however, have lower inpatient mortality (6.4% vs 9.1%; P < .001).

Complex care
“The care for patients with DA-IE is very complex and we agree with the American Association of Thoracic Surgery guidelines that it involves a ‘specialized endocarditis team,’ including cardiology, cardiac surgery, infectious disease, neurologist, nephrologist, addiction specialists, case management and nursing,” the authors wrote. “Unfortunately, treatment for opioid addiction after hospitalization is low. The two most common reasons for this are that patients were not ready to stop using illicit drugs or they did not have health care coverage to afford appropriate treatment. The care of patients with DA-IE after discharge should include follow-up with drug rehabilitation.”

In this retrospective cohort study using data from the NIS database, researchers analyzed the hospitalizations that occurred between 2002 and 2016 of patients with a primary or secondary diagnosis of IE (median age, 68 years; 51% men; 72% white; 50.9% with hypertension; 26.9% with diabetes; 12.4% on Medicaid). A total of 954,709 hospitalizations were included, with 9.9% of patients having drug abuse.

“Further research is needed on a geographic level to identify clusters or ‘hot zones’ of DA-IE outbreaks such as in rural areas where opioids are more likely to be abused,” the authors wrote. “Lastly, we show the need for resource allocations and public health interventions to target the young, poor, Caucasian population, most at risk at a national level.” – by Scott Buzby

Disclosures: The authors report no relevant financial disclosures.

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