Validation of an Algorithm to Identify Infective Endocarditis in People Who Inject Drugs

Ball, Laura; Sherazi, Adeel; Laczko, Dora; Gupta, Kaveri; Koivu, Sharon; Weir, Matthew A.; Mele, Tina; Tirona, Rommel G.; McCormick, John K.; Silverman, Michael

doi:10.1097/mlr.0000000000000838

Cited by 33 publications

(25 citation statements)

References 13 publications

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“…Prior work in other settings has demonstrated a similar lack of sensitivity when using ICD-10 diagnosis codes to identify IDU-IE [ 16 ]. To compensate, some researchers have suggested restricting age ranges [ 17 , 18 ] or adding codes for blood-borne pathogens such as hepatitis C or HIV [ 18 ]. However, this selects for PWID who preferentially engage in needle-sharing and who may have different characteristics than those using syringe exchange facilities or taking other precautions.…”

Section: Discussionmentioning

confidence: 99%

Use of ICD-10 Codes for Identification of Injection Drug Use–Associated Infective Endocarditis Is Nonspecific and Obscures Critical Findings on Impact of Medications for Opioid Use Disorder

Marks

Nolan

Jiang

et al. 2020

Open Forum Infectious Diseases

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Background No International Classification of Diseases 10 th revision (ICD-10) diagnosis code exists for injection drug use-associated infective endocarditis (IDU-IE). Instead, public health researchers regularly use combinations of non-specific ICD-10 codes to identify IDU-IE; however, the accuracy of these codes has not been evaluated. Methods We compared commonly used ICD-10 diagnosis codes for IDU-IE to a prospectively collected patient cohort diagnosed with IDU-IE at Barnes-Jewish Hospital to determine the accuracy of ICD-10 diagnosis codes used in IDU-IE research Results ICD-10 diagnosis codes historically used to identify IDU-IE were inaccurate, missing 36.0% and misclassifying 56.4% of patients prospectively identified in this cohort. Use of these non-specific ICD-10 diagnosis codes resulted in substantial biases against the benefit of medications for opioid use disorder (MOUD) with relation to both AMA discharge and all-cause mortality. Specifically, when data from all patients with ICD-10 code combinations suggestive of IDU-IE was used, MOUD was associated with an increased risk of AMA discharge (RR 1.12; 95% CI 0.48 - 2.64). In contrast, when only patients confirmed by chart review as having IDU-IE were analyzed, MOUD was protective (RR 0.49; 95% CI 0.19 - 1.22). Use of MOUD was associated with a protective effect in time to all-cause mortality in Kaplan-Meier analysis only when confirmed IDU-IE cases were analyzed (p=0.007) Conclusions Studies using non-specific ICD-10 diagnosis codes for IDU-IE should be interpreted with caution. In the setting of an ongoing overdose crisis and a syndemic of infectious complications, a specific ICD-10 diagnosis code for IDU-IE is urgently needed

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Section: Discussionmentioning

confidence: 99%

Use of ICD-10 Codes for Identification of Injection Drug Use–Associated Infective Endocarditis Is Nonspecific and Obscures Critical Findings on Impact of Medications for Opioid Use Disorder

Marks

Nolan

Jiang

et al. 2020

Open Forum Infectious Diseases

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“…We adapted a validated algorithm that used International Statistical Classification of Diseases and Related Health Problems, Tenth Revision inpatient diagnosis codes for endocarditis with hepatitis C or drug use disorders (opioids, cocaine, stimulants, and psychoactive substances) that had a sensitivity of 93%, specificity of 61%, and positive predictive value of 83% (eTable 1 in the Supplement ). 24 …”

Section: Methodsmentioning

confidence: 99%

Association of Treatment With Medications for Opioid Use Disorder With Mortality After Hospitalization for Injection Drug Use–Associated Infective Endocarditis

Kimmel

Walley

et al. 2020

JAMA Netw Open

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IMPORTANCE Although hospitalizations for injection drug use-associated infective endocarditis (IDU-IE) have increased during the opioid crisis, utilization of and mortality associated with receipt of medication for opioid use disorder (MOUD) after discharge from the hospital among patients with IDU-IE are unknown. OBJECTIVE To assess the proportion of patients receiving MOUD after hospitalization for IDU-IE and the association of MOUD receipt with mortality. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used a population registry with person-level medical claims, prescription monitoring program, mortality, and substance use

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“…DUA-IE was identified among IE cases by the presence of a diagnosis code for recreational drug use, withdrawal, dependence or poisoning, excluding diagnoses for marijuana or unspecified drug use. Persons born after 1965 diagnosed with hepatitis C (HCV) were also coded for DUA-IE, given the high propensity of HCV to be transmitted through recreational injection and the common method of utilizing HCV as a criterion in identifying DUA-IE (1,21). All IE hospitalizations not meeting these criteria were classified as non-DUA-IE.…”

Section: Methodsmentioning

confidence: 99%

Trends in Drug Use–Associated Infective Endocarditis and Heart Valve Surgery, 2007 to 2017

et al. 2018

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Background: Drug use-associated infective endocarditis (DUA-IE) is rising during the opioid epidemic. Infective endocarditis (IE) can require valve surgery, but surgical treatment of DUA-IE has invoked controversy and the extent of its use is unknown. Objective: To examine hospitalization trends for DUA-IE, the proportion with surgery, patient characteristics, length of stay and charges. Design: Ten-year analysis of a statewide hospital discharge database. Setting: North Carolina hospitals, 2007–2017. Patients: All patients hospitalized for IE aged ≥ 18 years. Measurements: Annual trends in all IE hospitalizations and those with valve surgery, stratified by patients’ drug use. Characteristics of DUA-IE surgical hospitalizations including demographics, length of stay, disposition and charges. Results: Of 22,825 IE hospitalizations, 2,602 (11%) were for DUA-IE. Valve surgery was performed in 1,655 (7%) IE hospitalizations, including 285 (17%) for DUA-IE. Annual DUA-IE hospitalizations increased from 0.92 to 10.95 per 100,000, and DUA-IE hospitalizations with surgery rose from 0.10 per 100,000 to 1.38 per 100,000. In the final year, surgeries for DUA-IE comprised 42% of IE valve surgeries. Compared to other IE surgical patients, DUA-IE patients were younger (median age 33 vs. 56), more commonly female (47% vs. 33%) and White (89% vs. 63%), and primarily insured by Medicaid (38%) or uninsured (35%). Hospital stays for DUA-IE were longer (median 27 vs. 17 days) with higher median charges ($250,994 vs. $198,764). Charges for 282 DUA-IE hospitalizations exceeded $78,000,000. Limitations: Reliance on administrative data and billing codes. Conclusions: DUA-IE hospitalizations and valve surgeries increased over twelve-fold and DUA-IE approached half of all IE valve surgeries. The swell of DUA-IE patients is reshaping the scope, type, and financing of healthcare resources needed for effective IE treatment.

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Validation of an Algorithm to Identify Infective Endocarditis in People Who Inject Drugs

Abstract: This algorithm will enable researchers to examine epidemiological trends in PWID-associated infective endocarditis.

Cited by 33 publications

References 13 publications

Use of ICD-10 Codes for Identification of Injection Drug Use–Associated Infective Endocarditis Is Nonspecific and Obscures Critical Findings on Impact of Medications for Opioid Use Disorder

Use of ICD-10 Codes for Identification of Injection Drug Use–Associated Infective Endocarditis Is Nonspecific and Obscures Critical Findings on Impact of Medications for Opioid Use Disorder

Association of Treatment With Medications for Opioid Use Disorder With Mortality After Hospitalization for Injection Drug Use–Associated Infective Endocarditis

Trends in Drug Use–Associated Infective Endocarditis and Heart Valve Surgery, 2007 to 2017

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