Author + information
- Received September 20, 2018
- Revision received October 19, 2018
- Accepted October 29, 2018
- Published online February 4, 2019.
- Sarah E. Rudasill, BAa@Sarah_Rudasill,
- Yas Sanaiha, MDa,
- Alexandra L. Mardock, BAa,
- Habib Khoury, BSa,
- Hanning Xing, BSa,
- James W. Antoniosa,
- James A. McKinnell, MDb and
- Peyman Benharash, MDa,∗ (, )@CoreLabUCLA
- aCardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, California
- bInfectious Disease Clinical Outcome Research Unit, Los Angeles Biomedical Research Institute at Harbor-UCLA, Los Angeles, California
- ↵∗Address for correspondence:
Dr. Peyman Benharash, Division of Cardiac Surgery, UCLA David Geffen School of Medicine, CHS 62-249, 10833 Le Conte Avenue, Los Angeles, California 90095.
Background Rising rates of hospitalization for infective endocarditis (IE) have been increasingly tied to rising injection drug use (IDU) associated with the opioid epidemic.
Objectives This study analyzed recent trends in IDU-IE hospitalization and characterized outcomes and readmissions for IDU-IE patients.
Methods The authors evaluated the National Readmissions Database (NRD) for IE cases between January 2010 and September 2015. Patients were stratified by IDU status and surgical versus medical management. Primary outcome was 30-day readmission and cause, with secondary outcomes including mortality, length of stay (LOS), adjusted costs, and 180-day readmission. The Kruskal-Wallis and chi-square tests were used to analyze baseline differences by IDU status. Multivariable regressions were used to analyze mortality, readmissions, LOS, and adjusted costs.
Results The survey-weighted sample contained 96,344 (77.8%) non–IDU-IE and 27,432 (22.2%) IDU-IE cases. IDU-IE increased from 15.3% to 29.1% of IE cases between 2010 and 2015 (p < 0.001). At index hospitalization, IDU-IE was associated with reduced mortality (6.8% vs. 9.6%; p < 0.001) but not 30-day readmission (23.8% vs. 22.9%; p = 0.077) relative to non–IDU-IE. Medically managed IDU-IE patients had higher LOS (β = 1.36 days; 95% confidence interval [CI]: 0.71 to 2.01), reduced costs (β = −$4,427; 95% CI: −$7,093 to −$1,761), and increased readmission for endocarditis (18.1% vs. 5.6%; p < 0.001), septicemia (14.0% vs. 7.3%; p < 0.001), and drug abuse (4.3% vs. 0.7%; p < 0.001) compared with medically managed non–IDU-IE. Surgically managed IDU-IE patients had increased LOS (β = 4.26 days; 95% CI: 2.73 to 5.80) and readmission for septicemia (15.6% vs. 5.2%; p < 0.001) and drug abuse (7.3% vs. 0.9%; p < 0.001) compared with non−IDU-IE.
Conclusions The incidence of IDU-IE continues to rise nationally. Given the increased readmission for endocarditis, septicemia, and drug abuse, IDU-IE presents a serious challenge to current management of IE.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received September 20, 2018.
- Revision received October 19, 2018.
- Accepted October 29, 2018.
- 2019 American College of Cardiology Foundation
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