key: cord-0728534-x0lca2mq
authors: Dai, Zheng; Smith, Gordon S.; Hendricks, Brian; Bhandari, Ruchi
title: Brief report: Cause of death among people discharged from infective endocarditis related hospitalization—West Virginia, 2016–2019
date: 2022-03-09
journal: Clin Cardiol
DOI: 10.1002/clc.23812
sha: 4864da20301fc5f2e68214d2ee5b31108efa7b32
doc_id: 728534
cord_uid: x0lca2mq

BACKGROUND AND OBJECTIVES: Compare proportion of all‐cause and cause‐specific mortality among West Virginia Medicaid enrollees who were discharged from infective endocarditis (IE) hospitalization with and without opioid use disorder (OUD) diagnosis. METHODS: The proportions of cause‐specific deaths among those who were discharged from IE‐related hospitalizations were compared by OUD diagnosis. RESULTS: The top three underlying causes of death discharged from IE hospitalization were accidental drug poisoning, mental and behavioral disorders due to polysubstance use, and cardiovascular diseases. Of the total deaths occurring among patients discharged after IE‐related hospitalization, the proportion has increased seven times from 2016 to 2019 among the OUD deaths while it doubled among the non‐OUD deaths. DISCUSSION AND CONCLUSIONS: Of the total deaths occurring among patients discharged after IE‐related hospitalization, the increase is higher in those with OUD diagnosis. OUD is becoming a significantly negative impactor on the survival outcome among IE patients. It is of growing importance to deliver medication for OUD treatment and harm reduction efforts to IE patients in a timely manner, especially as the COVID‐19 pandemic persists.

Opioid addiction has been a growing epidemic in the United States (US) reflected by the rapidly rising rates of opioid use and opioid overdose. 1 The 2018 National Survey on Drug Use and Health (NSDUH) estimated that 2 million Americans were diagnosed with opioid use disorder (OUD) 2 which is likely an underestimate due to self-reported data and exclusion of populations at high risk of OUD in NSDUH. Only a fifth of them received specialty addiction treatment 2 ;

and among those accessing treatment, less than a third received medication for opioid use disorder (MOUD). 3 Driven by surging synthetic opioids and polysubstance use with stimulants, alcohol, and benzodiazepines, there has been a drastic increase in the drug overdose deaths. 4 However, we might only be seeing the tip of the iceberg of drug-related deaths. While drug poisoning is the direct cause of death, opioid use and misuse is attributable to deaths caused by several co-occurring medical conditions including lung disease, cancer, mental illness, HIV/AIDS, hepatitis, and infective endocarditis (IE). 3 Board granted this study exemption as this is a secondary data analysis used retrospective deidentified records (protocol number 2104295379), and an informed consent was not applied to this study.

The annual death counts were grouped by the underlying cause of death defined by ICD-10 chapters. The χ2 tests were used to compare demographics, number of IE-related hospitalizations, and death counts between deceased with and without an OUD diagnosis.

Fisher's exact tests were employed when the sample sizes of death counts were small. Between the OUD and non-OUD decedents discharged from IE-related hospitalization, the Student's t-test was used to compare the number of IE-related hospitalizations and Wilcoxon signed-rank test was used to compare the age at death. Statistically significant level was set at 0.05. 7 Although IE itself can be a fatal complication, the increasing number of deaths among this population is likely associated with increasing use of OUD (e.g., reusing or sharing contaminated syringes). 5, 8 MOUD has been shown to be effective in reducing opioid use and preventing overdose. 1 A study found that the receipt of medication for OUD is associated with 70% decrease in all-cause mortality after injection drug use associated IE hospitalization; however, it is the long retention and close compliance with the treatment that save people's life, not just the initiation of medication for OUD. 9 Strikingly, of the total deaths occurring among patients discharged from IE-related hospitalization, those with OUD are dying at a much younger age compared to those IE decedents without OUD diagnosis (18.5 years younger at death), which is consistent with other studies. 8 However, we might only see the tip of the iceberg of OUD as the underlying cause of death in WV due to its underdiagnosis in rural patients. 10 Given the high proportion of deaths among the OUD patients hospitalized for IE, inpatient OUD treatment is an important touchpoint that could save lives. Future studies need to explore the impact of COVID-19 pandemic added to the long-existing opioid pandemic on the survival outcome among people discharged from IE-related hospitalization. 

Of the total deaths occurring among patients discharged after IE-related hospitalization, the increase is higher in those with OUD diagnosis. This is despite the fact that OUD is underdiagnosed in patients with IE. Hence, it is a cause of grave public health concern, highlighting the importance of delivering MOUD treatment and harm reduction efforts in a timely manner, especially during the time Pathologies likely related to infective endocarditis A41.9, B37.6 <10

Other pathologies including neoplasms, diseases of the respiratory system, and so forth multiple causes of death analyses and expand OUD identification beyond claims data.

Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: a cohort study

Key Substance Use and Mental Health Indicators in the United States: results from the 2018 National Survey on Drug Use and Health. Substance Abuse & Mental Health Services Administration

Centers for Disease Control and Prevention (CDC). Drug overdose mortality by state

Changes in the association of rising infective endocarditis with mortality in people who inject drugs

Trends in drug use-associated infective endocarditis and heart valve surgery

Mortality, morbidity, and cardiac surgery in injection drug use (IDU)-associated versus non-IDU infective endocarditis: the need to expand substance use disorder treatment and harm reduction services

Predictors of mortality and adverse events in patients with infective endocarditis: a retrospective real world study in a surgical centre

Association of treatment with medications for opioid use disorder with mortality after hospitalization for injection drug use-associated infective endocarditis

Prevalence of documented alcohol and opioid use disorder diagnoses and treatments in a regional primary care practice-based research network

State variation in certifying manner of death and drugs involved in drug intoxication deaths

The authors appreciated Dr. Carol Stocks from Office of Health Affairs, West Virginia University, for her support in data access and study design.This study was supported in part by the following awards: National Institute of General Medical Sciences (2U54GM104942), National Institute of Drug Abuse (R21DA040187 and 1UG3DA044825).

The authors declare no conflicts of interest.

The data that support the findings of this study are available upon reasonable request made to the Office of Health Affairs. Restrictions apply to the availability of these data, which were used under approval of research request. Please contact Dr. Zheng Dai for further information.

http://orcid.org/0000-0002-5943-0748