Trends in Drug Use-Associated Infective Endocarditis and Heart Valve Surgery, 2007 to 2017: A Study of Statewide Discharge Data.
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Background:Drug use-associated infective endocarditis (DUA-IE) is increasing as a result of the opioid epidemic. Infective endocarditis may require valve surgery, but surgical treatment of DUA-IE has invoked controversy, and the extent of its use is unknown. Objective:To examine hospitalization trends for DUA-IE, the proportion of hospitalizations with surgery, patient characteristics, length of stay, and charges. Design:10-year analysis of a statewide hospital discharge database. Setting:North Carolina hospitals, 2007 to 2017. Patients:All patients aged 18 years or older hospitalized for IE. Measurements:Annual trends in all IE admissions and in IE hospitalizations with valve surgery, stratified by patients' drug use status. Characteristics of DUA-IE surgical hospitalizations, including patient demographic characteristics, length of stay, disposition, and charges. Results:Of 22 825 IE hospitalizations, 2602 (11%) were for DUA-IE. Valve surgery was performed in 1655 IE hospitalizations (7%), including 285 (17%) for DUA-IE. Annual DUA-IE hospitalizations increased from 0.92 to 10.95 and DUA-IE hospitalizations with surgery from 0.10 to 1.38 per 100 000 persons. In the final year, 42% of IE valve surgeries were performed in patients with DUA-IE. Compared with other surgical patients with IE, those with DUA-IE were younger (median age, 33 vs. 56 years), were more commonly female (47% vs. 33%) and white (89% vs. 63%), and were primarily insured by Medicaid (38%) or uninsured (35%). Hospital stays for DUA-IE were longer (median, 27 vs. 17 days), with higher median charges ($250 994 vs. $198 764). Charges for 282 DUA-IE hospitalizations exceeded $78 million. Limitation:Reliance on administrative data and billing codes. Conclusion:DUA-IE hospitalizations and valve surgeries increased more than 12-fold, and nearly half of all IE valve surgeries were performed in patients with DUA-IE. The swell of patients with DUA-IE is reshaping the scope, type, and financing of health care resources needed to effectively treat IE. Primary Funding Source:National Institutes of Health.
Heart Valve Diseases
Length of Stay
Heart Valve Prosthesis Implantation
Published Version (Please cite this version)10.7326/M18-2124
Publication InfoSchranz, Asher J; Fleischauer, Aaron; Chu, Vivian H; Wu, Li-Tzy; & Rosen, David 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). pp. 31-40. 10.7326/M18-2124. Retrieved from https://hdl.handle.net/10161/19925.
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Dr. Chu's clinical research is focused on staphylococci and endocarditis (IE). She is the director of the International Collaboration on Endocarditis (ICE), a group of investigators from 78 sites in 32 countries worldwide that is dedicated to further the understanding of infective endocarditis. The ICE database comprises > 5000 cases of endocarditis and is designed to answer questions that could not be answered from a single-center study. The current focus of this group is surgica
Professor in Psychiatry and Behavioral Sciences
Education/Training: Pre- and post-doctoral training in mental health service research, psychiatric epidemiology (NIMH T32), and addiction epidemiology (NIDA T32) from Johns Hopkins University School of Public Health (Maryland); Fellow of the NIH Summer Institute on the Design and Conduct of Randomized Clinical Trials.Director: Duke Community Based Substance Use Disorder Research Program.Research interests: COVID-19, Opioid misuse, Opioid overdose, Opioid use disorder
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