Geographic Trends, Patient Characteristics, and Outcomes of Infective Endocarditis Associated With Drug Abuse in the United States From 2002 to 2016

by | Addiction

https://www.ahajournals.org/doi/10.1161/JAHA.119.012969

Comment; It’s good to “know the enemy” and identify those at risk, this paper identifies those at greatest risk from heart infections from IV drug abuse.

Amer N. Kadri, Bryan Wilner, Adrian V. Hernandez, Georges Nakhoul, Johnny Chahine, Brian Griffin, Gosta Pettersson, Richard Grimm, Jose Navia, Steven Gordon, Samir R. Kapadia, and Serge C. HarbOriginally published18 Sep 2019https://doi.org/10.1161/JAHA.119.012969Journal of the American Heart Association. 2019;8:e012969

Abstract

Background

There has been an increase in the prevalence of drug abuse (DA) in the national opioid epidemic. With increasing DA, there is an increased risk of infective endocarditis (IE). There are limited recent data evaluating national trends on the incidence and geographical distribution of DA‐IE. We aim to investigate those numbers as well as the determinants of outcome in this patient population.

Methods and Results

Hospitalized patients with a primary or secondary diagnosis of IE based on the International Classification of Diseases, Ninth and Tenth Revisions (ICD‐9, ICD‐10) were included. We described the national and geographical trends in DA‐IE. We also compared DA‐IE patients’ characteristics and outcomes to those with IE, but without associated drug abuse (non‐DA‐IE) using Poisson regression models. Incidence of DA‐IE has nearly doubled between 2002 and 2016 All US regions were affected, and the Midwest had the highest increase in DA‐IE hospitalizations (annual percent change=4.9%). Patients with DA‐IE were younger, more commonly white males, poorer, had fewer comorbidities, and were more likely to have human immunodeficiency virus, hepatitis C, concomitant alcohol abuse, and liver disease. Their length of stay was longer (9 versus 7 days; P<0.001) and were more likely to undergo cardiac surgery (7.8% versus 6.2%; P<0.001), but their inpatient mortality was lower (6.4% versus 9.1%; P<0.001).

Conclusions

DA‐IE is rising at an alarming rate in the United States. All regions of the United States are affected, with the Midwest having the highest increase in rate. Young‐adult, poor, white males were the most affected.

Clinical Perspective

What Is New?
  • We found that patients with drug‐abuse–associated infective endocarditis were younger, more commonly male and white, more likely to have Medicaid insurance, and in the lowest quartile of median household income.
  • These patients underwent cardiac or valve surgery more often, had a higher median length of stay, and a higher hospitalization cost, but a lower inpatient mortality.
  • Geographically, we found that drug abuse infective endocarditis is increasing across all regions of the United States, with the Midwest having the highest annual percent increase.
What Are the Clinical Implications?
  • We believe these findings are alarming from a public health standpoint and outline the need for an immediate tailored action plan.
Dr. Raymond Oenbrink
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