Rising Number of Infective Endocarditis Cases Linked to Opioid Epidemic

An alarming number of people in the United States are developing infective endocarditis, in large part, due to the current opioid epidemic, according to a study published in the Journal of the American Heart Association.

“Infective endocarditis related to drug abuse is a nationwide epidemic,” said Serge Harb, MD, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio. “These patients are among the most vulnerable — young and poor, and also frequently have HIV, hepatitis C, and alcohol abuse.”

For the study, Amer Kadri, MD, Cleveland Clinic Lerner College of Medicine, and colleagues analysed data from the National Inpatient Sample registry from 2002 to 2016 on nearly 954,709 patients with infective endocarditis. They compared the characteristics and outcomes of patients with drug abuse-related infective endocarditis with those of patients who had infective endocarditis without associated drug abuse.

During the 14 years studied, researchers found that the prevalence ratio for drug abuse-related heart infections nearly doubled in the United States, from 8% to 16%. All geographic regions saw increases, and the highest jump occurred in the Midwest at nearly 5% per year.

They also found those with infective endocarditis related to drug abuse:

● Were predominantly young, white men (median age 38 years);
● Were poorer, with nearly 42% having a median household income in the lowest national quartile, and about 45% are covered by Medicaid;
● Had higher rates of HIV, hepatitis C, and alcohol abuse compared with patients with infective endocarditis who are not drug abusers;
● Had longer hospital stays and higher health care costs; and
● Were more likely to undergo heart surgery, yet less likely to die while hospitalised. Lower death rates are likely due to their significantly younger age.

“Nationwide public health measures need to be implemented to address this epidemic, with targeted regional programs to specifically support patients at increased risk,” said Dr. Harb. “Specialised teams, including but not limited to cardiologists, infectious disease specialists, cardiac surgeons, nurses, addiction specialists, case managers, and social workers are needed to care for these patients.”

“Appropriately treating the cardiovascular infection is only 1 part of the management plan,” he concluded. “Helping these patients address their addictive behaviours with social supports and effective rehabilitation programs is central to improving their health and preventing drug abuse relapses.”