Multidisciplinary Treatment Team Approach to Cardiac Surgery in Patients with Injection Drug Use-Related Infective Endocarditis

E. Degife¹, A. Acuna Higaki¹, C. Brooks¹, N. Wells¹, A. Amabile², A. Geirsson³, M. B.. Weimer^1
1Yale School of Medicine, New Haven, Connecticut ²Yale University School of Medicine, New Haven, Connecticut ³Yale University, New Haven, Connecticut

Purpose: The incidence of injection drug use related infective endocarditis (IDU-IE) has risen in the last ten years with the worsening of the opioid overdose epidemic. People with IDU-IE can have complicated hospitalizations and multidisciplinary treatment including addiction treatment is recommended to decrease morbidity and mortality.

Methods: The aim of this study was to characterize outcomes of patients treated by a multidisciplinary endocarditis treatment team (MEET). MEET was created at our institution in 2018, consisting of addiction medicine, anesthesia, cardiology, cardiac surgery, infectious disease, case management, nursing, and social work clinicians. The MEET convenes biweekly to discuss patients with IDU-IE and optimize patients’ care Manual chart review was employed to review the outcomes of 78 patients who underwent cardiac surgery for IDU-IE and were seen by the MEET between November 2018 and June 2023. Mean follow-up of the cohort via chart review was 16.8 months. Descriptive statistics were used to describe the preoperative status and postoperative clinical course and hospital outcomes.

Results: The average age of the cohort was 38.8 years (SD 11.2), and 35 (44.8%) were male. Primary substance use disorder (SUD) was opioid use disorder (OUD) in 75 (96.2%) patients; 62 (79.5%) had a secondary SUD. 52 (66.7%) had history of enrollment in a SUD program in the last 30 days. With regards to endocarditis characteristics, 14 (17.9%) had S. aureus endocarditis and six (7.7%) had prosthetic valve endocarditis. Location of endocarditis was most commonly tricuspid valve (44 patients, 56.4%), followed by aortic valve (13 patients, 16.7%) and mitral valve (nine patients, 11.5%). 12 patients (15.4%) had multiple valve involvement. Postoperatively, seven (9.0%) patients experienced operative mortality. 66/68 (97.1%) of the surviving patients with primary OUD were started on medication for OUD, and 63 of the 71 total patients (88.7%) who survived to discharge were referred to SUD treatment. 58/71 (81.6%) of patients followed up with addiction medicine within thirty days. Thirty-day hospital readmission occurred in 20 patients (28.2%). Freedom from recurrent IE was observed in 59/71 (83.1%) patients who survived until discharge, with redo surgery in 9 patients occurring at a mean of 8.0 months after index surgery.

Conclusion: Use of a multidisciplinary team to treat patients with IDU-IE is feasible, and allows for improved follow-up, near complete SUD treatment, and reduction of recurrent endocarditis compared to previously reported outcomes. Adoption of this model could help to address the growing IDU-IE in the context of the opioid epidemic.

Identify the source of the funding for this research project: None