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Rising heart infections tied to U.S. opioid epidemic

(Reuters Health) – As the opioid epidemic continues in the U.S., more cases of an infection that damages the heart are being seen, researchers say.

Between 2002 and 2016, rates of infective endocarditis doubled, with much of the increase occurring in young, poor, white men who also tended to have higher rates of alcohol abuse, hepatitis C and HIV, the study authors report in the Journal of the American Heart Association.

“Infective endocarditis is a very serious infection … that can lead to heart failure, valve destruction, stroke and even death,” said Dr. Serge Harb of the Cleveland Clinic’s Heart and Vascular Institute in Ohio, the study’s senior author.

The infection typically can’t be treated with antibiotics or heart surgery alone, he added. Multidisciplinary care is often needed to treat the heart, drug addiction and other complications, and the cost and time can add up quickly. Patients often need to be readmitted for subsequent episodes as well.

“Patients affected are vulnerable: they are young, have low income and commonly have other serious infections,” he told Reuters Health by email. “They need help.”

Harb and colleagues analyzed data from the largest publicly available inpatient database in the U.S., which records information about millions of hospital stays each year. They looked at nearly 1 million cases between 2002 and 2016 that had a primary or secondary diagnosis of infective endocarditis, including about 94,000, or 10%, with a drug abuse diagnosis as well.

Nationwide during that period, the proportion of patients hospitalized with infective endocarditis who also had a diagnosis of drug abuse doubled from 8% to 16%. The increase occurred in all U.S. regions but was greatest in the Midwest and West.

Nationally, the average age of patients with infective endocarditis was 68, but among those who also had drug abuse diagnoses, it was 38.

Intravenous drug use is a particular risk factor for infective endocarditis, the study team notes.

The subset of younger patients with concurrent drug abuse was most often male, on Medicaid, and in the lowest quartile of median household income. They also more often underwent cardiac or valve surgery, had a longer stay in the hospital and higher hospitalization costs.

“Infective endocarditis related to substance abuse is a nationwide epidemic,” Harb said. “Nationwide public health measures and multidisciplinary teams are needed to address this rapidly growing nationwide problem.”

A limitation of the study, the study authors note, is that the database only provided a geographical breakdown by region rather than state or urban versus rural communities, which would be helpful in identifying clusters or “hot zones.”

Future research should look at relapse and reinfection related to treatment and surgical intervention, said Dr. Peyman Benharash of the University of California, Los Angeles, who wasn’t involved in the study.

“It’s become a huge ethical debate about reinfection of the valves and what to do,” he told Reuters Health by phone. “Do you offer a second operation?”

After surgery, for instance, patients must take antibiotics, often intravenously, for several weeks. Since patients are discharged home with the intravenous line, doctors worry that those who haven’t recovered from their substance abuse problems may continue to inject by using it at home, Benharash said. However, physicians can’t keep patients at the hospital for weeks at a time to monitor their progress and recovery.

“Consumers need to get behind societal programs that help people get treated,” he said. “This can happen on a national level but also at the local level where families can provide support.”

SOURCE: Journal of the American Heart Association, online September 18, 2019.

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