Asher J. Schranz, MD; Aaron Fleischauer, PhD; Vivian H. Chu, MD, MHS; Li-Tzy Wu, RN, ScD, MA; David L. Rosen, MD, PhD
Presented in part at IDWeek, San Francisco, California, 4 October 2018.
Acknowledgment: The authors thank Myron Cohen, MD (University of North Carolina) for manuscript review, Farnaz Chowdhury (North Carolina State Center for Health Statistics) for discharge data expertise, and Elizabeth Suarez (University of North Carolina) for assistance in identifying diagnostic codes.
Grant Support: By grants 5 T32 AI 070114-12 from the National Institute of Allergy and Infectious Diseases (Dr. Schranz); 1 R34 AI 122958-01, 4 UL1 TR 001117-04, 4 R25 HD 076475-04, R01 DE 023375, and 1 R25 HL 135304-01A1 from the National Institutes of Health (NIH) (Dr. Chu); UG1 DA 040317, R01 MD 007658, and K12 HL 138030-02 from NIH (Dr. Wu); and R25 DA 013582 from the Clinical Addiction Research and Education Program of the National Institute on Drug Abuse. Dr. Wu is also supported by the Patient-Centered Outcomes Research Institute (PCORI).
Disclosures: Dr. Schranz reports grants from National Institute of Allergy and Infectious Diseases and National Institute on Drug Abuse and data support from North Carolina State Center for Health Statistics during the conduct of the study. Dr. Chu reports personal fees from UpToDate and Theravance outside the submitted work. Dr. Wu reports grants from NIH and research support from PCORI and Alkermes outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2124.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Available from Dr. Schranz (e-mail, firstname.lastname@example.org).
Corresponding Author: Asher J. Schranz, MD, 130 Mason Farm Road (Bioinformatics), CB #7030, Chapel Hill, NC 27599; e-mail, email@example.com.
Current Author Addresses: Drs. Schranz and Rosen: 130 Mason Farm Road (Bioinformatics), CB #7030, Chapel Hill, NC 27599.
Dr. Fleischauer: 1902 Mail Service Center, Raleigh, NC 27699.
Dr. Chu: Duke University Medical Center, Box 102359, Durham NC 27710.
Dr. Wu: Duke South Hospital, Room 3521, Psychiatry Box 3903, Durham, NC 27710.
Author Contributions: Conception and design: A.J. Schranz, A. Fleischauer, L.T. Wu.
Analysis and interpretation of the data: A.J. Schranz, A. Fleischauer, V.H. Chu, L.T. Wu, D.L. Rosen.
Drafting of the article: A.J. Schranz, D.L. Rosen.
Critical revision for important intellectual content: A.J. Schranz, A. Fleischauer, V.H. Chu, L.T. Wu, D.L. Rosen.
Final approval of the article: A.J. Schranz, A. Fleischauer, V.H. Chu, L.T. Wu, D.L. Rosen.
Statistical expertise: A. Fleischauer, L.T. Wu, D.L. Rosen.
Administrative, technical, or logistic support: A.J. Schranz, A. Fleischauer.
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.
To examine hospitalization trends for DUA-IE, the proportion of hospitalizations with surgery, patient characteristics, length of stay, and charges.
10-year analysis of a statewide hospital discharge database.
North Carolina hospitals, 2007 to 2017.
All patients aged 18 years or older hospitalized for IE.
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.
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.
Reliance on administrative data and billing codes.
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.
National Institutes of Health.
Schranz AJ, Fleischauer A, Chu VH, et al. Trends in Drug Use–Associated Infective Endocarditis and Heart Valve Surgery, 2007 to 2017: A Study of Statewide Discharge Data. Ann Intern Med. 2019;170:31–40. [Epub ahead of print 4 December 2018]. doi: https://doi.org/10.7326/M18-2124
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Published: Ann Intern Med. 2019;170(1):31-40.
Published at www.annals.org on 4 December 2018
Cardiology, Hospital Medicine, Valvular Heart Disease.
Copyright © 2019 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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