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Infective endocarditis and the current opioid epidemic continue to rise in prevalence. Physicians need to examine current practices in order to effectively manage these patients.
We performed a retrospective institutional review of admissions for infective endocarditis (IE) during 2012 and 2017. Patient encounters were evaluated for affected valve, management, microbiology, embolic complications, rehospitalization, relapse, payor source, and discharge disposition.
From 2012 to 2017, there was a 101% increase in IE admissions and a 436% increase (p <0.00001) in IVDU related IE admissions. In 2012, 75% of patients were admitted to cardiology services vs 37% of patients in 2017 (p 0.0005). Affected valves remained similarly distributed: tricuspid (55% vs 54%), mitral (27% vs 23%), aortic (27% vs 25%) (p 0.63). Prevalence of methicillin resistant staphylococcus aureus endocarditis increased (15% vs 38%, p 0.0099). There was no difference in the distribution of embolic complications: lung (24% vs 37%), brain (24% vs 19%), bone/joint (9% vs 8%), cardiac (3% vs 0.5%), p 0.33. Management was different; in 2012 55% were treated medically vs 45% treated surgically. In 2017, 82% were treated medically vs 18% treated surgically, p <0.0003. Increase in death rates were nearly significant, 9% vs 25%, p 0.052. Discharge demographics from 2012 and 2017: skilled facility 43% vs 46%, against medical advice 9% vs 21%, home 24% vs 7%, and death 9% vs 25%, p 0.003. Rates of rehospitalization and relapse were similar (45% vs 49% and 24% vs 40%, p 0.34). Insurance payor was either Medicaid or a Medicaid subsidiary, 97% in 2012 and 94% in 2017 (p 0.53).
At our tertiary academic center we demonstrate a significant increase in IVDU related IE admissions, with a significant change in management trends from surgical to medical. Rates of relapse and rehospitalization remain stable, however deaths are rising. Due to nearly ubiquitous government-funded insurance, there is a significant financial burden on both hospital and community health systems.
Poster Hall, Hall F
Saturday, March 16, 2019, 3:45 p.m.-4:30 p.m.
Session Title: Valvular Heart Disease: Clinical 2
Abstract Category: 36. Valvular Heart Disease: Clinical
Presentation Number: 1182-461
- 2019 American College of Cardiology Foundation