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People who inject opioids or other drugs and develop a life-threatening heart infection require a unique approach to care that should include consultation with an addiction specialist, according to a new report from the American Heart Association.
The AHA’s previous guidance on the disease, called infective endocarditis, did not provide detailed information about how people who inject drugs are affected or how their care might differ from other people with the infection. The new scientific statement, published Wednesday in the AHA journal Circulation, addresses the gap.
Infective endocarditis occurs when bacteria enter the bloodstream and settle in the lining of the heart, a heart valve, or a blood vessel, causing inflammation. Of the more than 35,000 cases annually in the US, about 1 in 5 people die.
People who inject drugs are at increased risk of infective endocarditis if they are exposed to bacteria through the reuse of needles or other injection practices that are not sterile. Infections can also arise from other sources, such as poor dental hygiene, implanted medical devices, chronic skin disorders, or burns.
The new statement was prompted by advances in understanding the unique challenges of treating heart infections in people who inject drugs, Dr. Daniel C. DeSimone said in a news release. He is chairman of the statement’s writing committee and an associate professor of medicine at the Mayo Clinic in Rochester, Minnesota.
“More people who inject drugs are getting this potentially fatal heart infection,” he said. The proportion of people hospitalized in the United States with infective endocarditis related to injection drug use doubled between 2002 and 2016, from 8 percent to 16 percent, the research found.
People hospitalized for infective endocarditis should be screened for substance use, and people who inject drugs should be treated immediately for the condition, the statement said. This treatment should include medications approved by the Food and Drug Administration to reduce opioid-related withdrawal symptoms to improve the patient’s chances of completing treatment for endocarditis.
DeSimone said the statement-writing committee agreed a multidisciplinary team approach for people who inject drugs could improve their long-term prognosis, “which is currently unfortunate for this relatively young group of individuals “. Their average age is 38 years.
This multidisciplinary team may include cardiologists, cardiac surgeons and infectious disease specialists, as well as addiction medicine or addiction psychiatry specialists, pharmacists, social workers and nurse specialists, according to the release. Nurse specialists can help coordinate care as the patient transitions from hospitalization to outpatient and community care.
“Without a multidisciplinary approach, these people are not only more likely to develop infective endocarditis and other serious infections, but also have relapses of infection,” DeSimone said.
People who inject drugs should be considered for heart valve repair or replacement surgery whether or not they continue to inject drugs, the statement said.
“There is no evidence that the indications for valve surgery are different for people who inject drugs compared to people who don’t,” DeSimone said. “However, some treatment centers do not offer surgery, especially if the patient is currently injecting drugs or has undergone previous valve surgery. Those who develop infective endocarditis require complex care provided by professionals who look beyond stigma and bias to provide optimal and equitable care.”
He added that more studies are needed to evaluate the safety and effectiveness of medications used to treat infective endocarditis related to injection drug use.
The standard treatment for infective endocarditis, six weeks of intravenous antibiotics, is not always possible for people who inject drugs because they often leave the hospital before treatment is finished. Research suggests that other options, such as shorter intravenous antibiotic regimens followed by oral antibiotics, or oral antibiotics alone, could help these patients complete treatment.
The statement also calls for better public education about safer injection practices and to provide people who inject drugs with supplies to reduce potential harm, such as tourniquets, bandages and sterile water.
If you have questions or comments about this American Heart Association news release, please send an email [email protected].
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