Newswise — CHAPEL HILL, NC – The number of hospitalizations and surgeries to treat drug-associated infective endocarditis have both increased more than tenfold in North Carolina, according to doctors at the University of North Carolina School of Medicine who published their research in the Annals of Internal Medicine.

Endocarditis is an infection of one or more heart valves. Usually, this condition is seen in older patients as these valves age and become weaker. Yet, bacteria introduced into the body through injection drug use can also cause endocarditis, a phenomenon doctors around the state are seeing in startling rates.

“Drug-associated infective endocarditis is markedly increasing across North Carolina,” said first author Asher Schranz, MD, a fellow in the division of infectious diseases in the department of medicine and the UNC Institute for Global Health and Infectious Diseases. “It causes severe illness, and treatment is expensive. This condition has been somewhat overlooked, but it is a huge problem that needs appropriate attention.”

In collaboration with colleagues at Duke University and the N.C. Division of Public Health, Schranz studied state data on endocarditis hospitalizations from 2007 to 2017. They found a tenfold increase in the number of hospitalizations due to drug-associated infective endocarditis, with the most significant spike in the past four years. As recently as five years ago, less than 10 heart valve replacement surgeries were done to treat drug-associated endocarditis. Now, 109 surgeries are done annually in North Carolina to treat drug-associated endocarditis and overwhelmingly occur in young people. The median age of patients undergoing surgery for this condition is 33.

These surgeries come with an expensive price tag. The median hospital charge for the entire hospitalization with valve replacement surgery $251,000. More than 280 drug-associated endocarditis valve replacement surgeries were performed in North Carolina over the past 10 years, totaling about $78 million.

“We found that 73 percent of patients with drug-associated infective endocarditis were uninsured or on Medicaid,” Schranz said. “This means the costs of the surgery and hospitalization are absorbed by patients, individual hospitals, and government budgets, which finance Medicaid.”

The increase in the number of hospitalizations and surgeries for drug-associated infective endocarditis, as well as the burden the high cost of treatment has on hospitals and Medicaid, are the key takeaways from Schranz and his colleagues’ research. They would like future studies to focus on the long-term outcomes of valve replacement surgery, including reinfection, repeat surgeries, and drug overdose. The team would also like to explore ways to enhance delivery of addiction care services to patients while they are in the hospital and after discharge.

“Drug use-associated infective endocarditis is a severe aspect of the opioid epidemic impacting North Carolina and likely the whole country,” Shranz said. “Our findings add to the urgency to enhance the resources for addressing substance use disorders, which can include improving the infrastructure for delivering medications to treat opioid use disorder and linking patients to harm-reduction services.”

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