Opioid Epidemic Has Raised Infective Heart Disease Rates Nearly 12-Fold

Opioid Epidemic Has Raised Infective Heart Disease Rates Nearly 12-Fold

Cost of treating this drug-associated disease is enormous

A new study of drug-use associated endocarditis has revealed a nearly 12-fold increase in hospitalizations and surgeries during the decade 2007 to 2017 - revealing a serious aspect of the opioid epidemic that we haven't really noticed.

Infective endocarditis is frequently caused by one or another of the common staphylococcus bacteria getting into the blood stream. It can lodge on heart valves and spread to the entire endocardium, or surface of the heart. It requires massive antibiotic intervention, and very often also requires life-saving heart valve replacement surgery.

Drug-Use Associated Infective Endocarditis, called DUA-IE for short, is a notorious complication of intravenous drug use. "Dirty" needles get infected with a bacteria (or even a virus) which then enters the blood stream during injection. The results can be deadly.

The staggering increase in DUA-IE hospital admissions tracks right along with the increase in intravenous opioid use during the same period. It's alarming for several reasons:

  • It reveals another serious life-threatening, life-changing danger of the opioid epidemic that most of us have been completely unaware of, beyond the horror that accompanies opioid addiction and potential overdose fatalities.
  • It reveals an enormous and hidden cost of the epidemic. Multiple hospitalizations and complex heart surgeries don't come cheap, as the saying goes, averaging over $250,000 per case.
  • Finally, much of this enormous cost, the study found, is on the public dole or relatively uncollectible. Seventy-three percent of hospitalizations and surgeries were Medicaid or uninsured.

The state-wide North Carolina study was conducted by a team from the University of North Carolina in Chapel Hill under the leadership of Asher Schranz, MD. Results were published in Annals of Internal Medicine.

Statistical findings

The study examined the North Carolina Hospital Discharge Database and found 22,825 IE hospitalizations, of which 2602 (11 percent) were for DUA-IE. As we go through some of these numbers, note how the drug-associated percentages vastly outpace the rest:

  • Valve surgery was performed in 1,655 IE hospitalizations (7%), including 285 (17%) for DUA-IE.
  • Annual DUA-IE hospitalizations increased from 0.92 to 10.95 and DUA-IE hospitalizations with surgery from 0.10 to 1.38 per 100 000 persons.
  • In the final year, 42 percent of IE valve surgeries were performed in patients with DUA-IE.
  • Compared with non-drug-related patients with IE, those with DUA-IE were younger (median age, 33 vs. 56 years), were more commonly female (47% vs. 33%) and white (89% vs. 63%).
  • Patients were primarily insured by Medicaid (38%) or uninsured (35%).
  • Hospital stays for DUA-IE were longer than non-drug cases (median, 27 vs. 17 days), with higher median charges ($250,994 vs. $198,764).
  • Charges for only 282 DUA-IE hospitalizations exceeded $78 million.

Treatment for drug use beats treatment for IE

Cases in the state "began an acute upward trajectory in 2014," which collates with the sudden rise in fentanyls being added to street heroin nationwide.

The observed increase aligns with the growing number of deaths from heroin and synthetic narcotic use in North Carolina, the study said. Given the enormous cost of hospitalization and surgery, it would certainly be less costly to increase availability of "comprehensive outpatient treatment programs employing pharmacotherapy for opioid use."

"A rational public health approach would prioritize funding of inpatient and outpatient drug use disorder treatment, harm reduction, and other activities to prevent infective endocarditis," the study said.

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