Midwest Hospital Infective Endocarditis Rates Spiked During Opioid Crisis

Serena Day, MD

Hospital admissions for infective endocarditis related to intravenous drug use increased 436% from 2012-2017 at an Ohio medical center, reflecting a unique impact of the national opioid crisis.

Investigators found that overall admissions for infective endocarditis at Ohio State University Wexner Medical Center increased 101% from 2012 to 2017, with most of the increase coming from the 436% jump in drug-related cases. The research, which was presented at the American College of Cardiology (ACC) 2019 Annual Scientific Sessions in New Orleans, LA, found that most of the cases of endocarditis related to drug use involved heroin.

The study reported that in 2012, the hospital saw 196 cases of infective endocarditis—33 of those were related to intravenous drugs (16.8%). By 2017 that number rose to 395, with 177 associated with drug use (44.8%).

“What’s most striking is how quickly this problem got out of hand,” lead author Serena Day, MD, a cardiology fellow at the Ohio State University, said in a statement. “Five years ago, this disease was very uncommon for us. Now, it’s become so common that we can’t keep up.”

The standard care for infective endocarditis is two-fold: antibiotics to combat the bacteria infecting the heart and surgery to replace damaged tissue. However, surgery increases the risk of infection because replacement valve tissue is more prone to infection. Day noted this has caused a shift in how patients are treated at the hospital, as doctors’ worry about patients with drug addiction being likely to continue to use intravenous drugs.

“Many of these patients continue to use, they continue to relapse, and they come back even sicker than they were before,” Day said. “This study underscores the fact that, without treating the addiction, these patients aren’t going to get better.”

The treatment shift is clear in the study results. In 2012, 55% of patients were treated medically with antibiotics and 45% with surgery. However, by 2017, 82% of patients were treated with antibiotics compared to 18% treated surgically (P = .0003).

Additionally, the study reported an increase in death rate for these patients from 9% in 2012 to 25% in 2017—a finding that was close to statistical significance (P = .052).

Day emphasized the need for a comprehensive approach to treating infective endocarditis for patients with comorbid addiction to intravenous drugs.

“As a nation, we need to be aware of these other complications of injection drug use,” Day said. “Treatment for this condition has to include addiction rehabilitation or we will continue to lose lives and precious health care resources.”

The study, “Infective Endocarditis Trends Amongst Intravenous Drug Users: An Examination of Practice Patterns in a Mid-western Tertiary Care Center,” was presented at ACC 2019.