Trends in Drug Use-Associated Infective Endocarditis and Heart Valve Surgery, 2007 to 2017: A Study of Statewide Discharge Data.

Schranz, Asher J

Fleischauer, Aaron

Chu, Vivian H

Wu, Li-Tzy

Rosen, David L

2020-02-03T03:49:51Z

2020-02-03T03:49:51Z

2019-01

2020-02-03T03:49:51Z

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.

2717120

0003-4819

1539-3704

https://hdl.handle.net/10161/19925

eng

American College of Physicians

Annals of internal medicine

10.7326/M18-2124

Heart Valves

Humans

Endocarditis

Heart Valve Diseases

Substance-Related Disorders

Hospitalization

Length of Stay

Heart Valve Prosthesis Implantation

Risk Factors

Retrospective Studies

Adult

Aged

Middle Aged

Hospital Charges

North Carolina

Female

Male

Trends in Drug Use-Associated Infective Endocarditis and Heart Valve Surgery, 2007 to 2017: A Study of Statewide Discharge Data.

Journal article

Wu, Li-Tzy|0000-0002-5909-2259

31

40

1

School of Medicine

Duke

Center for Child and Family Policy

Sanford School of Public Policy

Duke Clinical Research Institute

Institutes and Centers

Duke Institute for Brain Sciences

University Institutes and Centers

Institutes and Provost's Academic Units

Psychiatry & Behavioral Sciences, Social and Community Psychiatry

Psychiatry & Behavioral Sciences

Clinical Science Departments

Medicine, General Internal Medicine

Medicine

Medicine, Infectious Diseases

Published

170