Tuesday, March 28, 2023
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Health Sciences Clinical Professor of Family Medicine
University of California, Irvine School of Medicine
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This activity is intended for primary care physicians, infectious disease specialists, cardiologists, nurses, pharmacists, physician assistants, and other members of the healthcare team who care for patients at risk for endocarditis.
The goal of this activity is for learners to be better able to assess how COVID-19 might affect the risk for endocarditis among patients with opioid use disorder or cocaine use disorder.
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Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
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Health Sciences Clinical Professor of Family Medicine
University of California, Irvine School of Medicine
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Like other inflammatory viral infections such as influenza, COVID-19 has been associated with an increased risk for cardiovascular (CV) events during the period of acute infection, but how long does this window of increased risk last? Xie and colleagues examined this issue in a large cohort of adults receiving health care at the US Veterans Affairs health system. Their results were published in the March 2022 issue of Nature Medicine.[1]
In comparing adults with a history of COVID-19 with contemporary control participants without COVID-19, the hazard ratio for major adverse cardiovascular events (MACE) during the period 30 to 365 days after SARS-CoV-2 infection was 1.55 (95% CI: 1.5, 1.6). Remarkably, COVID-19 had a lasting effect in association with a broad range of CV outcomes, including ischemic heart disease, cerebrovascular disease, thromboembolism, inflammatory heart disorders, and dysrhythmia. Moreover, CV risk increased with the severity of COVID-19.
There have been reports that COVID-19 may also increase the risk for endocarditis. The current study by Wang and colleagues examines this issue in a high-risk group: adults with a history of opioid use disorder (OUD) or cocaine use disorder.
A new study provides more evidence that endocarditis associated with drug use is a significant and growing health concern and further demonstrates that this risk has been exacerbated by the COVID-19 pandemic.
The rate of infective endocarditis among individuals in the United States with OUD or cocaine use disorder increased in the 11-year period 2011 to 2022, with the steepest increase logged during the COVID-19 pandemic (2021-2022), according to the study.
A diagnosis of COVID-19 more than doubled the risk for a new diagnosis of endocarditis in patients with either cocaine (HR 2.24) or OUD (HR 2.23).
"Our data suggests that in addition to the major social disruption from the pandemic, including disrupted access to healthcare, COVID-19 infection itself is a significant risk factor for new diagnosis of endocarditis in drug using populations," wrote authors Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA), and colleagues.
"Drug using populations, particularly those who use cocaine or opioids, have some of the highest risk for endocarditis, and here we show that having a COVID-19 diagnosis further increases this risk," they added.
The study was published online December 13 in Molecular Psychiatry.[2]
The researchers analyzed electronic health record data collected from January 2011 through August 2022 for more than 109 million people across the United States, including more than 736,000 with an OUD and more than 379,000 with a cocaine use disorder.
In 2011, there were 4 cases of endocarditis per day for every 1 million people with OUD. By 2022, the rate had increased to 30 cases/d/1 million people with OUD.
Among individuals with cocaine use disorder or OUD, the risk of being hospitalized within 180 days after a diagnosis of endocarditis was higher in persons with than without COVID-19 (67.5% vs 58.7%; HR 1.21).
The risk of dying within 180 days after a new diagnosis of endocarditis was also higher in persons with than without COVID-19 (9.2% vs 8%; HR 1.16).
The study also showed that Black and Hispanic individuals had a lower risk for COVID-19--associated endocarditis than non-Hispanic White individuals, which is consistent with a higher prevalence of injection drug use in non-Hispanic White populations compared with Black or Hispanic populations, the researchers pointed out.
Volkow and colleagues said their findings highlight the need to screen drug users for endocarditis and link them to infectious disease and addiction treatment if they contract COVID-19.
"People with substance use disorder already face major impediments to proper healthcare due to lack of access and stigma," Volkow said in a news release.[3]
"Proven techniques like syringe service programs, which help people avoid infection from re-used or shared injection equipment, can help prevent this often fatal and costly condition," Volkow added.
The authors said it will also be important to determine exactly how SARS-CoV-2 viral infection exacerbates the risk for endocarditis in drug users.
Support for the study was provided by the National Institute on Aging, National Institute on Alcohol Abuse and Alcoholism, the Clinical and Translational Science Collaborative of Cleveland, and the National Cancer Institute Case Comprehensive Cancer Center. The authors reported no relevant financial relationships.
