‘Alarming’ number of heart infections can be traced back to opioid epidemic

The opioid crisis is to blame for an “alarming” number of cases of infective endocarditis, according to the American Heart Association.

In a Sept. 18 study published in the Journal of the American Heart Association, Serge G. Harb, MD, and colleagues reported that, over a 14-year study period, the prevalence ratio for drug-abuse-related heart failure infections nearly doubled in the U.S. Drug abuse is one of the most prominent risk factors for infective endocarditis, which affects nearly 34,000 patients per year and kills one-fifth.

“Infective endocarditis related to drug abuse is a nationwide epidemic,” Harb, an assistant professor of medicine at the Cleveland Clinic Lerner College of Medicine, said in a release. “These patients are among the most vulnerable—young and poor, and also frequently have HIV, hepatitis C and alcohol abuse.”

Harb and his team analyzed 2002-2016 data from the National Inpatient Sample for their study, identifying nearly 1 million people who were hospitalized with infective endocarditis. Some patients were admitted as a result of drug abuse; others presented with endocarditis from other causes, like high blood pressure, diabetes, heart failure or kidney disease.

The prevalence of drug-abuse-related infective endocarditis doubled over the 14-year period, the researchers reported, from 8% in 2002 to 16% in 2016. All regions in the U.S. saw an increase, but the greatest was in the Midwest, which experienced a nearly 5% jump in the rate of drug-related infections per year.

Harb et al. said patients with infective endocarditis related to drug abuse were more often young, white men—the median age in the cohort was 38—and had higher rates of HIV, hepatitis C and alcohol abuse than their counterparts who didn’t use drugs. They also had longer hospital stays and higher healthcare costs despite being on average poorer than their peers; 42% had a median household income in the lowest quartile and 45% were covered by Medicaid.

“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. “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.”