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Opioid epidemic causes surge in infective endocarditis

Stemming from the opioid crisis, the rate of hospitalizations for drug use–associated infective endocarditis increased markedly in North Carolina over the past decade, according to findings published in Annals of Internal Medicine.

“Drug use–associated infective endocarditis (DUA-IE) is increasing as a result of the opioid epidemic,” Asher J. Schranz, MD, from the University of North Carolina at Chapel Hill, and colleagues wrote. “Infective endocarditis may require valve surgery, but surgical treatment of DUA-IE has invoked controversy, and the extent of its use is unknown.”

Schranz and colleagues performed an analysis of North Carolina’s hospital discharge database from 2007 to 2017 to determine statewide trends, characteristics and charges for DUA-IE hospitalizations. Data were stratified by patients’ drug use status.

The researchers identified 22,825 IE hospitalizations among patients aged 18 years or older, 11% of which (n = 2,602) were for DUA-IE. Among 1,655 IE hospitalizations, valve surgery was performed, 17% of which (n = 285) were among patients with DUA-IE.

There was a 12-fold annual increase in DUA-IE hospitalizations from 0.92 to 10.95 per 100,000 persons over the course of the period studied. Additionally, there was a 13-fold increase in DUA-IE hospitalizations with valve surgery, from 0.1 to 1.38 per 100,000 persons. These increases were not seen in patients with infective endocarditis not associated with drug use.

In 2017, nearly half (42%) of IE valve surgeries were for DUA-IE. Patients with DUA-IE tended to be younger (median age, 33 vs. 56 years), female (47% vs. 33%), white (89% vs. 63%) and primarily insured by Medicaid (38%) or uninsured (35%), compared with other patients with IE. For patients with DUA-IE, hospital stays were more likely to be longer (median, 27 vs. 17 days) and have higher median charges ($250,994 vs. $198,764).

For the 282 DUA-IE hospitalizations included in this study, charges surpassed $78 million.

“Drug use-associated IE is a critical, emerging public health issue that is affecting the lives of young persons, burdening health systems and public insurance payers, and fundamentally reshaping the epidemiology and management of endocarditis,” Schranz and colleagues concluded. “Enhancing the multidisciplinary infrastructure to address treatment and prevention of DUA-IE, including better access to addiction care in the inpatient and outpatient settings, should be an urgent priority.” – by Alaina Tedesco

Disclosures: Schranz reports receiving grants from the National Institute of Allergy and Infectious Diseases and National Institute on Drug Abuse, as well as data support from North Carolina State Center for Health Statistics. Please see study for all other authors’ relevant financial disclosures.