In the Journals

Substance use disorder increases mortality risk after endocarditis surgery

Alysse G. Wurcel

High rates of morbidity and mortality after valve replacement surgery were seen in patients with substance use disorder-related infective endocarditis, according to a study published in the Annals of Thoracic Surgery.

“Anyone that’s taking care of someone who is in the hospital for endocarditis, whether you be an addictions medicine person or a cardiologist, should understand how substance use disorder works, how it’s a chronic disease, how some people benefit from treatment, how there are medications available,” Alysse G. Wurcel, MD, MS, infectious disease physician at Tufts Medical Center, told Cardiology Today. “Just having a discussion about that even for cardiologists is important. It is within the scope of practice of all of us as clinicians to address substance use disorder as a chronic disease and not a moral failing.”

Infective endocarditis

Researchers analyzed data from 228 patients (median age at surgery, 53 years; 68% men) from The Society of Thoracic Surgeons Adult Cardiac Surgery Database with infective endocarditis who underwent cardiac surgery between 2002 and 2016. Other information that was assessed included demographic, perioperative and disease-related data. Substance use disorder-related endocarditis was defined as those with documentation of illicit drug use before the operation.

The outcome of interest was mortality, which was subdivided into short-term mortality (within 6 months of the operation), midterm mortality (between 6 months and 5 years after the operation) and extended-term mortality (more than 5 years after the operation).

Of the patients in the study, 35% had substance use disorder-related infective endocarditis.

Death occurred in 38% of patients. More deaths occurred in patients with substance use disorder-related endocarditis compared with those without the condition (48% vs. 32%; P = .025). The strongest predictor of mortality was substance use disorder (adjusted HR = 2.41; 95% CI, 1.38-4.2).

The differences in short-term or extended-term mortality did not reach statistical significance. Despite this, patients with substance use disorder-related endocarditis were more likely to die within the midterm period compared with those without the condition (53% vs. 31%; P < .003).

Future research

“What’s needed and what some colleagues are doing already is prospective cohorts looking at people with substance use disorder and saying what is it that you need at 1 month after the valve replacement, 3 months after the valve replacement, 1 year after the valve replacement,” Wurcel said in an interview. “What is it that you need to treat the endocarditis, what is it that you need to treat the substance use disorder, what is it that you need in life like food, transportation and housing. In the end if you invest in a person’s life, meaning housing, transportation and food, it potentially can save on the costs of hospitalizations if that person gets ill again as it relates to relapses in substance use disorders.” – by Darlene Dobkowski

For more information:

Alysse G. Wurcel, MD, MS, can be reached at Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, 800 Washington Ave., Boston, MA 02111; email: awurcel@tuftsmedicalcenter.org; Twitter: @iddoc1978.

Disclosures: Wurcel reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Alysse G. Wurcel

High rates of morbidity and mortality after valve replacement surgery were seen in patients with substance use disorder-related infective endocarditis, according to a study published in the Annals of Thoracic Surgery.

“Anyone that’s taking care of someone who is in the hospital for endocarditis, whether you be an addictions medicine person or a cardiologist, should understand how substance use disorder works, how it’s a chronic disease, how some people benefit from treatment, how there are medications available,” Alysse G. Wurcel, MD, MS, infectious disease physician at Tufts Medical Center, told Cardiology Today. “Just having a discussion about that even for cardiologists is important. It is within the scope of practice of all of us as clinicians to address substance use disorder as a chronic disease and not a moral failing.”

Infective endocarditis

Researchers analyzed data from 228 patients (median age at surgery, 53 years; 68% men) from The Society of Thoracic Surgeons Adult Cardiac Surgery Database with infective endocarditis who underwent cardiac surgery between 2002 and 2016. Other information that was assessed included demographic, perioperative and disease-related data. Substance use disorder-related endocarditis was defined as those with documentation of illicit drug use before the operation.

The outcome of interest was mortality, which was subdivided into short-term mortality (within 6 months of the operation), midterm mortality (between 6 months and 5 years after the operation) and extended-term mortality (more than 5 years after the operation).

Of the patients in the study, 35% had substance use disorder-related infective endocarditis.

Death occurred in 38% of patients. More deaths occurred in patients with substance use disorder-related endocarditis compared with those without the condition (48% vs. 32%; P = .025). The strongest predictor of mortality was substance use disorder (adjusted HR = 2.41; 95% CI, 1.38-4.2).

The differences in short-term or extended-term mortality did not reach statistical significance. Despite this, patients with substance use disorder-related endocarditis were more likely to die within the midterm period compared with those without the condition (53% vs. 31%; P < .003).

Future research

“What’s needed and what some colleagues are doing already is prospective cohorts looking at people with substance use disorder and saying what is it that you need at 1 month after the valve replacement, 3 months after the valve replacement, 1 year after the valve replacement,” Wurcel said in an interview. “What is it that you need to treat the endocarditis, what is it that you need to treat the substance use disorder, what is it that you need in life like food, transportation and housing. In the end if you invest in a person’s life, meaning housing, transportation and food, it potentially can save on the costs of hospitalizations if that person gets ill again as it relates to relapses in substance use disorders.” – by Darlene Dobkowski

For more information:

Alysse G. Wurcel, MD, MS, can be reached at Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, 800 Washington Ave., Boston, MA 02111; email: awurcel@tuftsmedicalcenter.org; Twitter: @iddoc1978.

Disclosures: Wurcel reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.