Infective Endocarditis Related to Drug Use Is on the Rise

A new study has found that an increased number of individuals across the United States are developing infective endocarditis as a result of the widespread opioid epidemic.

When bacteria or fungi in the bloodstream enter the heart’s inner lining or valves, infective endocarditis can occur; drug use is a major risk factor for the infection. Each year, approximately 34,000 individuals in the United States receive treatment for this condition, of which approximately 20% die.

The study, published in the Journal of the American Heart Association, reports that the trend is mostly affecting young, white, poor men who also have higher rates of HIV, hepatitis C, and alcohol abuse.

"Infective endocarditis related to drug abuse is a nationwide epidemic," senior author Serge C. Harb, MD, assistant professor of medicine at Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, said in a statement. "These patients are among the most vulnerable—young and poor, and also frequently have HIV, hepatitis C, and alcohol abuse."

For the study, a team of investigators analyzed data from the National Inpatient Sample registry from 2002-16. The registry included 1 million patients who were hospitalized and diagnosed with infective endocarditis. The study team analyzed data from patients with an infection linked to drug abuse in comparison with patients with heart infections linked to other causes.

The investigators assessed data from a 14-year-period and found that the prevalence ratio for heart infections related to drug abuse jumped from 8% to 16%. In fact, increases were observed in all geographic regions, with the highest increase occurring in the Midwest at nearly 5% per year.

Additionally, the team uncovered that infective endocarditis linked to drug abuse was more common in young, white men (median age 38 years) who were poorer, with nearly 42% reporting a median household income in the lowest national quartile, and 45% of whom were covered by Medicaid.

Furthermore, patients in this population were more likely to have higher rates of HIV, hepatitis C, and alcohol abuse when compared with patients who did not have a drug-related infection. The patients also had longer hospital stays and higher health care costs, as they were more likely to undergo heart surgery; however, this patient population was less likely to die during hospitalization, which is likely attributable to the younger age.

The study authors also noted that patients with infections that were not related to drug use more frequently had high blood pressure, diabetes, heart failure, kidney disease, and lung disease.

Limitations of the study included that the registry was based on diagnostic codes and did not include hospital transfers that the registry provided only general information by region, without details specific on the state and local level.

"Nationwide public health measures need to be implemented to address this epidemic, with targeted regional programs to specifically support patients at increased risk," Harb said in the statement. "Specialized 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 one part of the management plan. Helping these patients address their addictive behaviors with social supports and effective rehabilitation programs is central to improving their health and preventing drug abuse relapses."