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Infective Endocarditis in Injection Drug Users
Study Questions:
What are the recent trends in injection drug use (IDU)-infective endocarditis (IE) hospitalization and outcomes and readmissions for IDU-IE patients?
Methods:
The investigators evaluated the National Readmissions Database (NRD) for IE cases between January 2010 and September 2015. Patients were stratified by IDU status and surgical versus medical management. Primary outcome was 30-day readmission and cause, with secondary outcomes including mortality, length of stay (LOS), adjusted costs, and 180-day readmission. The Kruskal-Wallis and chi-square tests were used to analyze baseline differences by IDU status. Multivariable regressions were used to analyze mortality, readmissions, LOS, and adjusted costs.
Results:
The survey-weighted sample contained 96,344 (77.8%) non–IDU-IE and 27,432 (22.2%) IDU-IE cases. IDU-IE increased from 15.3% to 29.1% of IE cases between 2010 and 2015 (p < 0.001). At index hospitalization, IDU-IE was associated with reduced mortality (6.8% vs. 9.6%; p < 0.001) but not 30-day readmission (23.8% vs. 22.9%; p = 0.077) relative to non–IDU-IE. Medically managed IDU-IE patients had higher LOS (β = 1.36 days; 95% confidence interval [CI], 0.71-2.01), reduced costs (β = ─$4,427; 95% CI, ─$7,093 to ─$1,761), and increased readmission for endocarditis (18.1% vs. 5.6%; p < 0.001), septicemia (14.0% vs. 7.3%; p < 0.001), and drug abuse (4.3% vs. 0.7%; p < 0.001) compared with medically managed non–IDU-IE. Surgically managed IDU-IE patients had increased LOS (β = 4.26 days; 95% CI, 2.73-5.80) and readmission for septicemia (15.6% vs. 5.2%; p < 0.001) and drug abuse (7.3% vs. 0.9%; p < 0.001) compared with non─IDU-IE.
Conclusions:
The authors concluded that the incidence of IDU-IE continues to rise nationally.
Perspective:
This study reports that the proportion of IDU-IE cases nationwide has continued to rise in parallel with the opioid epidemic and its rising rates of IDU. Furthermore, compared to those with non–IDU-IE, patients with IDU-IE have reduced mortality and no increased risk in the overall rate of 30- or 180-day readmissions. However, those with IDU-IE are significantly more likely to be readmitted for subsequent episodes of endocarditis, septicemia, and drug abuse, many of which may represent readmissions preventable with more aggressive care for substance abuse at the index hospitalization. These data highlight the importance of interventions for drug addiction with coordinated addiction counseling, which may offer a promising opportunity for reducing recurrent endocarditis and drug abuse relapse in IDU-IE patients.
Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Invasive Cardiovascular Angiography and Intervention, Prevention, Valvular Heart Disease, Cardiac Surgery and Arrhythmias, Cardiac Surgery and VHD, Interventions and Structural Heart Disease
Keywords: Cardiac Surgical Procedures, Behavior, Addictive, Counseling, Drug Users, Endocarditis, Endocarditis, Bacterial, Heart Valve Diseases, Hemorrhagic Septicemia, Length of Stay, Patient Readmission, Recurrence, Secondary Prevention, Sepsis, Substance-Related Disorders
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