Infective Endocarditis in Patients Addicted to Injected Opioid Drugs.
J Am Coll Cardiol
; 83(8): 811-823, 2024 Feb 27.
Article
em En
| MEDLINE
| ID: mdl-38383096
ABSTRACT
BACKGROUND:
Persons who inject drugs and require surgery for infective endocarditis have 2 potentially lethal diseases. Current postoperative rehabilitation efforts seem ineffective in preventing loss to follow-up, injection drug use relapse (relapse), and death.OBJECTIVES:
The purpose of this study was to characterize drug use, psychosocial issues, surgical outcome, and postoperative addiction management, as well as loss to follow-up, relapse, and mortality and their risk factors.METHODS:
From January 2010 to June 2020, 227 persons who inject drugs, age 36 ± 9.9 years, underwent surgery for infective endocarditis at a quaternary hospital having special interest in developing addiction management programs. Postsurgery loss to follow-up, relapse, and death were assessed as competing risks and risk factors identified parametrically and by machine learning. CIs are 68% (±1 SE).RESULTS:
Heroin was the most self-reported drug injected (n = 183 [81%]). Psychosocial issues included homelessness (n = 56 [25%]), justice system involvement (n = 150 [66%]), depression (n = 118 [52%]), anxiety (n = 104 [46%]), and post-traumatic stress disorder (n = 33 [15%]). Four (1.8%) died in-hospital. Medication for opioid use disorder prescribed at discharge increased from 0% in 2010 to 100% in 2020. At 1 and 5 years, conditional probabilities of loss to follow-up were 16% (68% CI 13%-22%) and 59% (68% CI 44%-65%), relapse 32% (68% CI 28%-34%) and 79% (68% CI 74%-83%), and mortality 21% (68% CI 18%-23%) and 68% (68% CI 62%-72%). Younger age, heroin use, and lower education level were predictors of relapse.CONCLUSIONS:
Infective endocarditis surgery can be performed with low mortality in persons who inject drugs, but addiction is far more lethal. Risk of loss to follow-up and relapse require more effective addiction strategies without which this major loss to society will continue.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Abuso de Substâncias por Via Intravenosa
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Endocardite
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Endocardite Bacteriana
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Usuários de Drogas
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article