Elsevier

The American Journal of Cardiology

Volume 183, 15 November 2022, Pages 137-142
The American Journal of Cardiology

Impact of Opioid Epidemic on Infective Endocarditis Outcomes in the United States: From the National Readmission Database

https://doi.org/10.1016/j.amjcard.2022.08.002Get rights and content

Infective endocarditis (IE) is associated with marked morbidity and mortality in the United States and parallels the opioid pandemic. Few studies explore this interaction and its effect on clinical outcomes. We analyzed contemporary patients admitted with IE to determine predictors of readmission in the United States. The 2017 National Readmission Database was used to identify index admissions in adults with the diagnosis of IE, based on the International Classification of Disease, 10th Revision codes. The primary outcome of interest was 30-day readmission. Secondary outcomes were mortality, hospital charges, and predictors of hospitalization readmission. Of 40,413 index admissions for IE, 5,558 patients (13.8%) were readmitted within 30 days. Patients who were readmitted were younger (55 ± 20 vs 61 ± 19 years, p <0.001) and more likely to have end-stage renal disease (12.2% vs 10.5%, p <0.001), hepatitis C virus (19.4% vs 12.6%, p <0.001), HIV (1.8% vs 1.2%, p = 0.001), opioid abuse (23.9% vs 15%, p <0.001), cocaine use (7.3% vs 4.4%, p <0.001), and other substance abuse (8.5 vs 5.6, p <0.001). Patients readmitted were less likely to have diabetes mellitus (27.8% vs 29.4%, p = 0.01), hypertension (56.9% vs 64%, p <0.001), heart failure (37.7% vs 40%, p <0.001), chronic kidney disease (31.2% vs 32%, p <0.001), and peripheral vascular disease (3.6% vs 4.6%, p = 0.001). The median cost of index admission for the total cohort was $84,325 (39,922 to 190,492). After adjusting for age, diabetes mellitus, heart failure, hypertension, and end-stage renal disease, opioid abuse (odds ratio [OR] 1.34; 95% confidence interval [CI] 1.23 to 1.46; p <0.001), cocaine use (OR 1.32; 95% CI 1.17 to 1.48; p <0.001), other substance abuse (OR 1.16; 95% CI 1.04 to 1.30; p = 0.008), and hepatitis C virus (OR 1.32; 95% CI 1.21 to 1.43; p <0.001) correlated with higher odds of 30-day readmission. These factors may present targets for future intervention.

Section snippets

Methods

Our data were derived from the 2017 NRD, under the Healthcare Cost and Utilization Project, supported by the Agency for Healthcare Research and Quality. The NRD is one of the largest publicly available all-payer inpatient care databases in the United States. This database represents 49.3% of total United States hospitalizations and 51.2% of the total United States population. Further details related to the NRD and data extraction methodology are available online.12 Because the NRD is a

Results

We identified 40,413 admissions for IE from the NRD in 2017 (January to November). Approximately 5,558 patients (13.8%) were readmitted within 30 days of discharge. Overall, 5,393 patients (10.9%) died during index hospitalization for IE. Baseline characteristics, hospital charges, geographic distribution, and variations of patients at index admission are presented in Figure 2 and Table 1.

Patients who were readmitted were younger (55 ± 20 vs 61 ± 19 years, p <0.001), and 44.5% of patients

Discussion

Hospitalizations for IE in the United States have been increasing over the last decade, with a marked increase in IE because of IVDU.4,13 In this study, we demonstrate in an adjusted analysis that substance abuse with opioids, cocaine, or other agents, and viral infection associated with IVDU, were predictive of 30-day readmission in patients with IE as opposed to traditional cardiovascular risk factors such as hypertension, PVD, or DM. An increase in opioid use has resulted from both oral

Disclosures

The authors have no conflicts of interest to declare.

References (21)

There are more references available in the full text version of this article.

Cited by (5)

Funding: none.

See page 142 for disclosure information.

View full text