Changes in the Association of Rising Infective Endocarditis With Mortality in People Who Inject Drugs

Abstract

Deaths from opioid abuse have increased markedly among an otherwise young and healthy population. 1 Approximately a million people used heroin in the United States in 2016, 2 times more than the number who used heroin in the entire period between 2002 and 2013. 2 Because people who inject drugs (PWID) are at risk for bacteremia, we hypothesized that their mortality from infective endocarditis has increased.

National Trends in Hospitalizations for Stroke Associated With Infective Endocarditis and Opioid Use Between 1993 and 2015

“…8,24,25 The rise in heroin use combined with these high-risk injection practices may explain why opioid-related IE is becoming more prevalent and leading to complications such as stroke and death. 5,9,11 Our study should be considered in light of several limitations. First, we used administrative claims data to establish diagnoses which may have resulted in misclassification of diagnoses.…”

“…7,8 The incidence of opioid-related IE is increasing, particularly among younger patients. 5,[9][10][11] Stroke is a neurologically devastating complication affecting nearly 20% of IE patients and often leads to long-term disability or death. [11][12][13] There are few data on trends in the occurrence of stroke as a complication of opioid-related IE, particularly in relation to the increasing severity of the opioid epidemic.…”

Emerging Viral and Bacterial Infections: Within an Era of Opioid Epidemic

“…Between 1996 and 2016, there were 55,212 deaths from IE associated with drug abuse (DA). The proportion of drug abuse-associated IE (DA-IE) deaths increased from 9.4% in 1999 to 18.9% in 2016 [ 76 ]. The proportion of deaths from DA-IE among patients younger than 35 years old exceeded the national average, as DA-IE deaths in this population increased from 12.4% in 1999 to 37.4% in 2016 [ 76 ].…”

“…The proportion of drug abuse-associated IE (DA-IE) deaths increased from 9.4% in 1999 to 18.9% in 2016 [ 76 ]. The proportion of deaths from DA-IE among patients younger than 35 years old exceeded the national average, as DA-IE deaths in this population increased from 12.4% in 1999 to 37.4% in 2016 [ 76 ]. These results were supported by another study showing the doubling of DA-IE in the USA from 8% in 2002 to 16.3% in 2016, with younger patients more frequently having comorbidities such as HIV, HCV, concomitant alcohol abuse, and liver disease.…”

Introductory Chapter: Introduction to Advanced Concepts in Endocarditis

“…The second growing population of patients at risk for developing endocarditis are patients with a history of intravenous substance abuse-and even more so, those who continue to abuse IV drugs having already undergone a surgical procedure to repair/replace an infected cardiac valve [3,4]. The global burden of substance abuse and the impact of infectious endocarditis are only recently been the sources of focused investigation with a growing appreciation of the magnitude of the problem [5]. Many of these patients tend to be younger-and as a function of their greater physiologic reserve, difficulties in getting appropriate access to healthcare and the means in which they become infected can result in this population presenting much later in the course of an infection with advanced cardiac structural destruction and are more likely to have polymicrobial or fungal infections.…”