Asher Schranz, MD Division of Infectious Disease Department of Medicine UNC School of Medicine

Marked Increase in Infected Heart Valves Due to Injected Opioids Interview with:

Asher Schranz, MD Division of Infectious Disease Department of Medicine UNC School of Medicine

Dr. Schranz

Asher Schranz, MD
Division of Infectious Disease
Department of Medicine
UNC School of Medicine What is the background for this study?

Response: The opioid crisis has led to several major infectious diseases concerns, including HIV and Hepatitis C.

Drug use-associated infective endocarditis (DUA-IE) is a less commonly discussed consequence of the opioid epidemic. DUA-IE is an infection of one or more heart valves that occurs from injecting drugs. It can be a severe, life-threatening infection and requires a long course of intravenous antibiotics as well as, in some cases, open heart surgery to replace an infected heart valve. Several studies over the past few years have shown that DUA-IE has been increasing.

Our study examined hospital discharges in North Carolina statewide from 2007 to 2017. We sought to update trends in DUA-IE and describe how much heart valve surgery was being performed for DUA-IE. We also aimed to report the demographics of persons who are undergoing heart valve surgery for DUA-IE and the charges, lengths of stay and outcomes of these hospitalizations. What are the main findings? 

Response: There has been marked year-to-year increases in both Drug use-associated infective endocarditis and heart valve surgeries for DUA-IE, primarily taking off in 2013. DUA-IE has increased twelve-fold in North Carolina. Heart valve surgeries for DUA-IE, which were uncommon in the state as recently as 2010, have increased thirteen-fold and now represent over 40% of all heart valve surgeries for infective endocarditis.

This problem is primarily occurring in young persons (median age of 33) who are uninsured or insured by Medicaid. While hospitalizations for DUA-IE that required heart valve surgery are still not incredibly common – there were 285 over ten years in North Carolina – they represent a major, possibly life-changing illness for patients and have the potential to significantly impact hospitals and insurance payers. These hospitalizations last a median of about a month and typically accrue a quarter-million dollars in hospital charges. For just 282 of these hospitalizations, the charges totaled nearly $80,000,000. Theoretically, any injected drug can lead to Drug use-associated infective endocarditis. However, we found that opioids (including heroin) were the most common drugs responsible for DUA-IE. What should readers take away from your report?

Response: Drug use associated infective endocarditis is a severe and underappreciated consequence of the opioid crisis that is sharply increasing. It is generally impacting young persons and resulting in long and costly hospitalizations which fall to hospitals and Medicaid.

Further,Drug use-associated infective endocarditis is fundamentally reshaping the landscape of endocarditis. Our findings should prompt health systems and providers to consider how we can best deliver the necessary comprehensive care that these patients need to address both their infection and substance use disorder.

While we focused on North Carolina, we suspect that similar trends may be occurring in other states hard-hit by the opioid crisis. What recommendations do you have for future research as a result of this work?

Response: We examined the total number of hospitalizations, rather than the unique number of persons affected. Unfortunately, after an episode of DUA-IE, persons can still be at-risk of having another episode of DUA-IE if they continue nonsterile injection practices. Further studies should determine how many total persons are impacted by DUA-IE and the frequency of repeat infections. From the perspective of clinical care, novel approaches to synergizing infectious diseases, cardiac surgery and addiction care are important, especially in areas where substance use disorder treatment services may be limited. 

I have no disclosures. Dr. Chu and Dr. Wu, coauthors of the study, have reported disclosures which are published with the article. 


Schranz AJ, Fleischauer A, Chu VH, Wu L, Rosen DL. Trends in Drug Use–Associated Infective Endocarditis and Heart Valve Surgery, 2007 to 2017A Study of Statewide Discharge Data. Ann Intern Med. [Epub ahead of print ] doi: 10.7326/M18-2124

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Last Updated on December 4, 2018 by Marie Benz MD FAAD