Opioid epidemic in the US fueling a steep rise in infections of the heart
The disease is widespread and analysis says the new trend predominantly affects young, white, poor men, who also have higher rates of HIV, hepatitis C, and alcohol abuse.
The US is in the grip of an opioid epidemic and an alarming number of young people are developing a life-threatening heart infection that can result from drug abuse.
The incidence of drug-abuse-related heart infections is increasing every year in the US and has nearly doubled - from 8 to 16% - between 2002 and 2016, according to a new study.
Stating that there has been an increase in the prevalence of drug abuse in the national opioid epidemic, the researchers say that with increasing drug abuse, there is an increased risk of infective endocarditis (IE), which are infections of either the heart's inner lining or valves.
Infective endocarditis occurs when bacteria or fungi in the bloodstream enter the heart's inner lining or valves. Nearly 34,000 people receive treatment for this condition each year, of which approximately 20% die. One of the major risk factors for infective endocarditis is drug abuse, says the research team from Cleveland Clinic, and other universities.
The researchers found that drug-abuse related infective endocarditis has increased across all regions of the US over the past 14 years. Experts say the findings are alarming from a public health standpoint and outline the need for an immediate tailored action plan.
“Drug abuse continues to rise in the US, and otherwise healthy populations have been particularly affected. The number of deaths secondary to an opioid-related drug overdose in 2016 was five times higher than in 1999 and drug-related deaths from heroin nearly tripled during this period. In 2017, the US Department of Health and Human Services declared the US opioid epidemic a public health emergency,” says the study published in the Journal of the American Heart Association, an open-access one.
It further says, “The opioid epidemic has led to increased infectious-related morbidity and mortality, including infective endocarditis. Drug abuse is a major risk factor for IE and patients who have IE from intravenous drug abuse have significant morbidity and mortality.”
According to Dr. Serge C. Harb, the study’s senior author, IE related to drug abuse is a nationwide epidemic. “Nationwide public health measures need to be implemented to address this epidemic, with targeted regional programs to specifically support patients at increased risk,” says Dr. Harb, who is an assistant professor of medicine at the Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.
For the study, the researchers analyzed data from the National Inpatient Sample registry - from 2002-2016 - on nearly one million hospitalized patients diagnosed with infective endocarditis. They wanted to compare patients with heart infections related to drug abuse to those with heart infections from other causes. The registry is the largest publicly available database of US hospitalizations.
“The overall incidence rate of infective endocarditis increased from 18 per 10,000 in 2002 to 29 per 10,000 in 2016. In those with drug abuse (related)-infective endocarditis, the incidence rate increased from 48 per 10,000 in 2002 to 79 per 10,000 in 2016. In patients with infective endocarditis, there has been a near doubling in the prevalence ratio of drug abuse from 2002 (8%) to 2016 (16%). All geographic regions saw increases, and the highest jump occurred in the Midwest at nearly 5% per year", says the study.
Some of the patients are among the most vulnerable - young and poor, and they also frequently have HIV, hepatitis C and alcohol abuse.
“Those with infective endocarditis related to drug abuse were predominantly young, white men (median age 38 years old); were poorer, with nearly 42% having a median household income in the lowest national quartile, and about 45% are covered by Medicaid. They also had higher rates of HIV, hepatitis C and alcohol abuse compared to patients with infective endocarditis who are not drug abusers,” says the researchers in their findings.
Further, those with drug-abuse related IE had longer hospital stays as well as higher health costs. They were more likely to undergo heart surgery but were less likely to die while hospitalized, shows analysis. Lower death rates among such patients are likely due to their significantly younger age, the researchers explain.
According to the researchers, specialized teams, including cardiologists, infectious disease specialists, cardiac surgeons, nurses, addiction specialists, case managers, and social workers, are needed to care for these patients.
The researchers recommend that the care of patients with drug-abuse-related infective endocarditis after discharge should include follow-up with drug rehabilitation. This is critical as such patients have an approximately 10-fold higher hazard of death or reoperation compared with patients who do not inject drugs three to six months after the operation for IE, and it is suspected that this is due to continued drug use.
“Appropriately treating 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," adds Dr. Harb.
Diseases that occurred more frequently among patients with heart infections from causes other than drug abuse included high blood pressure, diabetes, heart failure, kidney and lung disease, shows analysis.