Infective endocarditis from injected drugs increases risk for clinical outcomes
Patients with infective endocarditis related to injection drug use had an increased readmission risk for endocarditis, drug abuse and septicemia, according to a study published in the Journal of the American College of Cardiology.
National Readmissions Database
Sarah E. Rudasill, a medical student at UCLA David Geffen School of Medicine, and colleagues analyzed data from patients aged 15 to 64 years from the National Readmissions Database who presented with infective endocarditis between 2010 and September 2015. The study included infective endocarditis not related to injection drug use cases (n = 96,344; mean age, 50 years; 41% women) or infective endocarditis related to injection drug use cases (n = 27,432; mean age, 38 years; 45% women).
Those with infective endocarditis related to injection drug use met three criteria: a diagnosis of bacterial or unspecified endocarditis, a procedure code linked to an injected illicit drug and no documentation of rheumatic or congenital heart disease that would predispose a patient to infective endocarditis. Patients were also stratified by surgical vs. nonsurgical management, according to the study.
The primary outcome of interest was 30-day readmission and the reason for the rehospitalization. Secondary outcomes of interest included length of stay, mortality, discharge location at index hospitalization and total adjusted costs. These outcomes also included 30- and 180-day readmission rates and causes.
Between 2010 and 2015, the proportion of infective endocarditis related to injection drug use increased from 15.3% to 29.1% (P < .001), the researchers wrote.
Patients with infective endocarditis related to injection drug use at index hospitalization had reduced mortality compared with those without the condition (6.8% vs. 9.6%; P < .001). This association was not seen for 30-day readmission (23.8% vs. 22.9%; P = .077).
Increased risk with infective endocarditis
Patients with medically managed infective endocarditis related to injection drug use had reduced costs (beta = –$4,427; 95% CI, –7,093 to –1,761) and longer lengths of stay (beta = 1.36 days; 95% CI, 0.71-2.01) compared with those with medically managed infective endocarditis not related to injection drug use, according to the researchers. In addition, these patients also had increased septicemia (14% vs. 7.3%; P < .001), readmission for endocarditis (18.1% vs. 5.6%; P < .001) and drug abuse (4.3% vs. 0.7%; P < .001).
Patients with surgically managed infective endocarditis related to injection drug use had increased readmission for septicemia (15.6% vs. 5.2%; P < .001), lengths of stay (beta = 4.26 days; 95% CI, 2.73-5.8) and drug abuse (7.3% vs. 0.9%; P < .001) vs. those without the condition.
“Several issues remain unsolved in [infective endocarditis related to injection drug use], including its incidence in different parts of the world, the beneficial effect or lack of effect of early surgery in this population, the value of valve repair compared with valve replacement and the respective prognosis of left-sided vs. right-sided [infective endocarditis related to injection drug use],” Gilbert Habib, MD, of the Assistance Publique Hopitaux de Marseille at La Timone Hospital in Marseille, France, and colleagues wrote in a related editorial. “Finally, although initial mortality seems to be lower in patients with [infective endocarditis related to injection drug use], their long-term mortality is unknown, and further studies are needed to assess the real benefit of surgery in this population, particularly in the subgroup of patients with persisting drug use.” – by Darlene Dobkowski
Disclosures: The authors of the study and editorial report no relevant financial disclosures.