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Problem Statement or Scientific Question: The purpose of this study was to evaluate the prevalence of intravenous drug-use (IVDU) in patients requiring surgery for prosthetic valve endocarditis (PVE) in a large, urban-based tertiary hospital during the current opioid epidemic.

Background/Project Intent: National statistics demonstrate that IVDU-associated infective endocarditis continues to rise, with higher rates of redo valve operations secondary to recurrent infections in people who inject drugs.1 IVDU PVE accounts for 34% to 58% of all cardiac valve operations for infective endocarditis. This population has a higher risk-adjusted hospital mortality and morbidity, with a 7±6% event-free 10-year survival.2-4

Methodology: Retrospective chart review was performed on patients who underwent surgical valve replacement for either native valve endocarditis (NVE) or PVE from 4/2019 to 3/2022. Two 24-month intervals were compared: 4/2019–3/2021 and 4/2021–3/2022. Inpatient recovery coaches and case navigators were in place for the later cohort. Chart review included age, IVDU, opioid use disorder (OUD), valve type, timeframe to valve reinfection, and in-hospital mortality.

Results: A comparison of the two-year cohorts demonstrated a 61% overall reduction in patients who underwent surgical valve replacement for infective endocarditis (72/166 vs. 28/139), with an increased prevalence of PVE, 35% (25/72) vs. 68% (19/28). IVDU PVE declined from 44% to 26% along with the presence of IVDU + OUD from 50% (36/72) to 18% (5/28). Time to redo surgery remained short for IVDU cohorts (9 and 14 months), compared to 7 and 9 years. IVDU PVE was more likely to affect the tricuspid valve, while non-drug PVE mostly affected the aortic valve in both time periods. In-hospital mortality rates remained similar despite younger age with a median of 37 and 38 compared 60 and 65-years old in the non-drug use cohort.

Value Proposition: Preventative efforts to reduce drug-use have the potential to reduce hospitalization, systematic infections, and premature mortality; shifting healthcare dollar spending from the care of morbidities to more novel approaches to promote individual and societal health across communities.

Conclusions: Between 2019 and 2022, there has been a reduction in the total number of surgical valve replacements for NVE with an overall increase in prevalence of PVE noted. However, the rate of IVDU-associated PVE has declined over time. Post pandemic OUD awareness and an increase in hospital and community-based interventions may have contributed to this positive trend; including the integration recovery coaches and case navigators to follow patients longitudinally and provide continuity structure.

References: Deo, S., Raza, S., Kalra, A., Deo, V., Altarabsheh, S., Markowitz, A., Sabik, J., Park, P. (2018). Admissions for Infective Endocarditis in Intravenous Drug Users. Journal of the American College of Cardiology, 17 (14). DOI:10.1016/j.jacc.2018.02.011 Geirsson A, Schranz A, Jawitz O, Mori M, Feng L, Zwischenberger BA, Iribarne A, Dearani J, Rushing G, Badhwar V, Crestanello JA. The Evolving Burden of Drug Use Associated Infective Endocarditis in the United States. Ann Thorac Surg. 2020 Oct;110(4):1185-1192. doi: 10.1016/j.athoracsur.2020.03.089. Epub 2020 May 6. PMID: 32387035; PMCID: PMC7502470. Tiako MJN, Mori M, Mahmood SUB, Shioda K, Mangi A, Yun, J, Geirsson A. (2018). Recidivism is the leading cause of death among intravenous drug users who underwent cardiac surgery for infective endocarditis. Seminars in Thoracic and Cardiovascular Surgery: 1-6. Schranz, A. J., Fleischauer, A., Chu, V. H., Wu, L. T., & Rosen, D. L. (2019). Trends in Drug Use-Associated Infective Endocarditis and Heart Valve Surgery, 2007 to 2017: A Study of Statewide Discharge Data. Annals of internal medicine, 170(1), 31–40. https://doi.org/10.7326/M18-2124 Mori, M., Bin Mahmood, S. U., Schranz, A. J., Sultan, I., Axtell, A. L., Sarsour, N., Hiesinger, W., Boskovski, M. T., Hirji, S., Kaneko, T., Woo, J., Tang, P., Jassar, A. S., Atluri, P., Whitson, B. A., Gleason, T., & Geirsson, A. (2020). Risk of reoperative valve surgery for endocarditis associated with drug use. The Journal of thoracic and cardiovascular surgery, 159(4), 1262–1268.e2. https://doi.org/10.1016/j.jtcvs.2019.06.055

Problem Statement or Scientific Question: The purpose of this study was to evaluate the prevalence of intravenous drug-use (IVDU) in patients requiring surgery for prosthetic valve endocarditis (PVE) in a large, urban-based tertiary hospital during the current opioid epidemic.

Background/Project Intent: National statistics demonstrate that IVDU-associated infective endocarditis continues to rise, with higher rates of redo valve operations secondary to recurrent infections in people who inject drugs.1 IVDU PVE accounts for 34% to 58% of all cardiac valve operations for infective endocarditis. This population has a higher risk-adjusted hospital mortality and morbidity, with a 7±6% event-free 10-year survival.2-4

Methodology: Retrospective chart review was performed on patients who underwent surgical valve replacement for either native valve endocarditis (NVE) or PVE from 4/2019 to 3/2022. Two 24-month intervals were compared: 4/2019–3/2021 and 4/2021–3/2022. Inpatient recovery coaches and case navigators were in place for the later cohort. Chart review included age, IVDU, opioid use disorder (OUD), valve type, timeframe to valve reinfection, and in-hospital mortality.

Results: A comparison of the two-year cohorts demonstrated a 61% overall reduction in patients who underwent surgical valve replacement for infective endocarditis (72/166 vs. 28/139), with an increased prevalence of PVE, 35% (25/72) vs. 68% (19/28). IVDU PVE declined from 44% to 26% along with the presence of IVDU + OUD from 50% (36/72) to 18% (5/28). Time to redo surgery remained short for IVDU cohorts (9 and 14 months), compared to 7 and 9 years. IVDU PVE was more likely to affect the tricuspid valve, while non-drug PVE mostly affected the aortic valve in both time periods. In-hospital mortality rates remained similar despite younger age with a median of 37 and 38 compared 60 and 65-years old in the non-drug use cohort.

Value Proposition: Preventative efforts to reduce drug-use have the potential to reduce hospitalization, systematic infections, and premature mortality; shifting healthcare dollar spending from the care of morbidities to more novel approaches to promote individual and societal health across communities.

Conclusions: Between 2019 and 2022, there has been a reduction in the total number of surgical valve replacements for NVE with an overall increase in prevalence of PVE noted. However, the rate of IVDU-associated PVE has declined over time. Post pandemic OUD awareness and an increase in hospital and community-based interventions may have contributed to this positive trend; including the integration recovery coaches and case navigators to follow patients longitudinally and provide continuity structure.

References: Deo, S., Raza, S., Kalra, A., Deo, V., Altarabsheh, S., Markowitz, A., Sabik, J., Park, P. (2018). Admissions for Infective Endocarditis in Intravenous Drug Users. Journal of the American College of Cardiology, 17 (14). DOI:10.1016/j.jacc.2018.02.011 Geirsson A, Schranz A, Jawitz O, Mori M, Feng L, Zwischenberger BA, Iribarne A, Dearani J, Rushing G, Badhwar V, Crestanello JA. The Evolving Burden of Drug Use Associated Infective Endocarditis in the United States. Ann Thorac Surg. 2020 Oct;110(4):1185-1192. doi: 10.1016/j.athoracsur.2020.03.089. Epub 2020 May 6. PMID: 32387035; PMCID: PMC7502470. Tiako MJN, Mori M, Mahmood SUB, Shioda K, Mangi A, Yun, J, Geirsson A. (2018). Recidivism is the leading cause of death among intravenous drug users who underwent cardiac surgery for infective endocarditis. Seminars in Thoracic and Cardiovascular Surgery: 1-6. Schranz, A. J., Fleischauer, A., Chu, V. H., Wu, L. T., & Rosen, D. L. (2019). Trends in Drug Use-Associated Infective Endocarditis and Heart Valve Surgery, 2007 to 2017: A Study of Statewide Discharge Data. Annals of internal medicine, 170(1), 31–40. https://doi.org/10.7326/M18-2124 Mori, M., Bin Mahmood, S. U., Schranz, A. J., Sultan, I., Axtell, A. L., Sarsour, N., Hiesinger, W., Boskovski, M. T., Hirji, S., Kaneko, T., Woo, J., Tang, P., Jassar, A. S., Atluri, P., Whitson, B. A., Gleason, T., & Geirsson, A. (2020). Risk of reoperative valve surgery for endocarditis associated with drug use. The Journal of thoracic and cardiovascular surgery, 159(4), 1262–1268.e2. https://doi.org/10.1016/j.jtcvs.2019.06.055

Prevalence of Intravenous Drug-Use Associated Prosthetic Valve Endocarditis- A Cohort Comparison over Time
Carolyn Martindale
Carolyn Martindale
Affiliations:
null
American College of Cardiology Quality Summit. Martindale C. 10/11/2023; 400300; 2519374;
user
Carolyn Martindale
Affiliations:
null
Problem Statement or Scientific Question: The purpose of this study was to evaluate the prevalence of intravenous drug-use (IVDU) in patients requiring surgery for prosthetic valve endocarditis (PVE) in a large, urban-based tertiary hospital during the current opioid epidemic.

Background/Project Intent: National statistics demonstrate that IVDU-associated infective endocarditis continues to rise, with higher rates of redo valve operations secondary to recurrent infections in people who inject drugs.1 IVDU PVE accounts for 34% to 58% of all cardiac valve operations for infective endocarditis. This population has a higher risk-adjusted hospital mortality and morbidity, with a 7±6% event-free 10-year survival.2-4

Methodology: Retrospective chart review was performed on patients who underwent surgical valve replacement for either native valve endocarditis (NVE) or PVE from 4/2019 to 3/2022. Two 24-month intervals were compared: 4/2019–3/2021 and 4/2021–3/2022. Inpatient recovery coaches and case navigators were in place for the later cohort. Chart review included age, IVDU, opioid use disorder (OUD), valve type, timeframe to valve reinfection, and in-hospital mortality.

Results: A comparison of the two-year cohorts demonstrated a 61% overall reduction in patients who underwent surgical valve replacement for infective endocarditis (72/166 vs. 28/139), with an increased prevalence of PVE, 35% (25/72) vs. 68% (19/28). IVDU PVE declined from 44% to 26% along with the presence of IVDU + OUD from 50% (36/72) to 18% (5/28). Time to redo surgery remained short for IVDU cohorts (9 and 14 months), compared to 7 and 9 years. IVDU PVE was more likely to affect the tricuspid valve, while non-drug PVE mostly affected the aortic valve in both time periods. In-hospital mortality rates remained similar despite younger age with a median of 37 and 38 compared 60 and 65-years old in the non-drug use cohort.

Value Proposition: Preventative efforts to reduce drug-use have the potential to reduce hospitalization, systematic infections, and premature mortality; shifting healthcare dollar spending from the care of morbidities to more novel approaches to promote individual and societal health across communities.

Conclusions: Between 2019 and 2022, there has been a reduction in the total number of surgical valve replacements for NVE with an overall increase in prevalence of PVE noted. However, the rate of IVDU-associated PVE has declined over time. Post pandemic OUD awareness and an increase in hospital and community-based interventions may have contributed to this positive trend; including the integration recovery coaches and case navigators to follow patients longitudinally and provide continuity structure.

References: Deo, S., Raza, S., Kalra, A., Deo, V., Altarabsheh, S., Markowitz, A., Sabik, J., Park, P. (2018). Admissions for Infective Endocarditis in Intravenous Drug Users. Journal of the American College of Cardiology, 17 (14). DOI:10.1016/j.jacc.2018.02.011 Geirsson A, Schranz A, Jawitz O, Mori M, Feng L, Zwischenberger BA, Iribarne A, Dearani J, Rushing G, Badhwar V, Crestanello JA. The Evolving Burden of Drug Use Associated Infective Endocarditis in the United States. Ann Thorac Surg. 2020 Oct;110(4):1185-1192. doi: 10.1016/j.athoracsur.2020.03.089. Epub 2020 May 6. PMID: 32387035; PMCID: PMC7502470. Tiako MJN, Mori M, Mahmood SUB, Shioda K, Mangi A, Yun, J, Geirsson A. (2018). Recidivism is the leading cause of death among intravenous drug users who underwent cardiac surgery for infective endocarditis. Seminars in Thoracic and Cardiovascular Surgery: 1-6. Schranz, A. J., Fleischauer, A., Chu, V. H., Wu, L. T., & Rosen, D. L. (2019). Trends in Drug Use-Associated Infective Endocarditis and Heart Valve Surgery, 2007 to 2017: A Study of Statewide Discharge Data. Annals of internal medicine, 170(1), 31–40. https://doi.org/10.7326/M18-2124 Mori, M., Bin Mahmood, S. U., Schranz, A. J., Sultan, I., Axtell, A. L., Sarsour, N., Hiesinger, W., Boskovski, M. T., Hirji, S., Kaneko, T., Woo, J., Tang, P., Jassar, A. S., Atluri, P., Whitson, B. A., Gleason, T., & Geirsson, A. (2020). Risk of reoperative valve surgery for endocarditis associated with drug use. The Journal of thoracic and cardiovascular surgery, 159(4), 1262–1268.e2. https://doi.org/10.1016/j.jtcvs.2019.06.055

Problem Statement or Scientific Question: The purpose of this study was to evaluate the prevalence of intravenous drug-use (IVDU) in patients requiring surgery for prosthetic valve endocarditis (PVE) in a large, urban-based tertiary hospital during the current opioid epidemic.

Background/Project Intent: National statistics demonstrate that IVDU-associated infective endocarditis continues to rise, with higher rates of redo valve operations secondary to recurrent infections in people who inject drugs.1 IVDU PVE accounts for 34% to 58% of all cardiac valve operations for infective endocarditis. This population has a higher risk-adjusted hospital mortality and morbidity, with a 7±6% event-free 10-year survival.2-4

Methodology: Retrospective chart review was performed on patients who underwent surgical valve replacement for either native valve endocarditis (NVE) or PVE from 4/2019 to 3/2022. Two 24-month intervals were compared: 4/2019–3/2021 and 4/2021–3/2022. Inpatient recovery coaches and case navigators were in place for the later cohort. Chart review included age, IVDU, opioid use disorder (OUD), valve type, timeframe to valve reinfection, and in-hospital mortality.

Results: A comparison of the two-year cohorts demonstrated a 61% overall reduction in patients who underwent surgical valve replacement for infective endocarditis (72/166 vs. 28/139), with an increased prevalence of PVE, 35% (25/72) vs. 68% (19/28). IVDU PVE declined from 44% to 26% along with the presence of IVDU + OUD from 50% (36/72) to 18% (5/28). Time to redo surgery remained short for IVDU cohorts (9 and 14 months), compared to 7 and 9 years. IVDU PVE was more likely to affect the tricuspid valve, while non-drug PVE mostly affected the aortic valve in both time periods. In-hospital mortality rates remained similar despite younger age with a median of 37 and 38 compared 60 and 65-years old in the non-drug use cohort.

Value Proposition: Preventative efforts to reduce drug-use have the potential to reduce hospitalization, systematic infections, and premature mortality; shifting healthcare dollar spending from the care of morbidities to more novel approaches to promote individual and societal health across communities.

Conclusions: Between 2019 and 2022, there has been a reduction in the total number of surgical valve replacements for NVE with an overall increase in prevalence of PVE noted. However, the rate of IVDU-associated PVE has declined over time. Post pandemic OUD awareness and an increase in hospital and community-based interventions may have contributed to this positive trend; including the integration recovery coaches and case navigators to follow patients longitudinally and provide continuity structure.

References: Deo, S., Raza, S., Kalra, A., Deo, V., Altarabsheh, S., Markowitz, A., Sabik, J., Park, P. (2018). Admissions for Infective Endocarditis in Intravenous Drug Users. Journal of the American College of Cardiology, 17 (14). DOI:10.1016/j.jacc.2018.02.011 Geirsson A, Schranz A, Jawitz O, Mori M, Feng L, Zwischenberger BA, Iribarne A, Dearani J, Rushing G, Badhwar V, Crestanello JA. The Evolving Burden of Drug Use Associated Infective Endocarditis in the United States. Ann Thorac Surg. 2020 Oct;110(4):1185-1192. doi: 10.1016/j.athoracsur.2020.03.089. Epub 2020 May 6. PMID: 32387035; PMCID: PMC7502470. Tiako MJN, Mori M, Mahmood SUB, Shioda K, Mangi A, Yun, J, Geirsson A. (2018). Recidivism is the leading cause of death among intravenous drug users who underwent cardiac surgery for infective endocarditis. Seminars in Thoracic and Cardiovascular Surgery: 1-6. Schranz, A. J., Fleischauer, A., Chu, V. H., Wu, L. T., & Rosen, D. L. (2019). Trends in Drug Use-Associated Infective Endocarditis and Heart Valve Surgery, 2007 to 2017: A Study of Statewide Discharge Data. Annals of internal medicine, 170(1), 31–40. https://doi.org/10.7326/M18-2124 Mori, M., Bin Mahmood, S. U., Schranz, A. J., Sultan, I., Axtell, A. L., Sarsour, N., Hiesinger, W., Boskovski, M. T., Hirji, S., Kaneko, T., Woo, J., Tang, P., Jassar, A. S., Atluri, P., Whitson, B. A., Gleason, T., & Geirsson, A. (2020). Risk of reoperative valve surgery for endocarditis associated with drug use. The Journal of thoracic and cardiovascular surgery, 159(4), 1262–1268.e2. https://doi.org/10.1016/j.jtcvs.2019.06.055

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