AHA: Addiction Management Is Key to Treating Heart Infections in Those Who Inject Drugs

A new statement from the American Heart Association stresses withdrawal medications and special care teams to prevent endocarditis in these individuals.

A unique approach to care, including consultation with an addition specialist, is essential to managing heart infections in individuals who inject drugs, opioids, and stimulants, according to an American Heart Association (AHA) scientific statement published in Circulation.

In the statement, the AHA highlighted the need for specialized care for those individuals, a population it has not addressed in its previous guidance.

“Advances in our understanding of the unique challenges to treating infective endocarditis in [individuals] who inject drugs compared to those who develop the infection due to other health conditions prompted this statement,” Daniel DeSimone, MD, chair of the scientific writing committee for the statement and an associate professor of medicine at the Mayo Clinic in Rochester, Minnesota, said in a statement.

“Effective treatment of infective endocarditis in [individuals] with injection drug use should also include treatment for substance use disorder. Without a multi-disciplinary approach, these individuals are not only more likely to develop infective endocarditis and other serious infections but also to have infection relapses,” DeSimone said.

The writing committee advised that a multi-disciplinary team approach can improve the long-term prognosis for the population. The team should include addiction medicine or addiction psychiatry specialists, cardiologists, cardiac surgeons, infectious diseases specialists, nurse specialists, pharmacists, and social workers.

The nurse specialists may provide coordinated care from the initial hospitalization, to outpatient, and community care support for substance use disorder, they added.

The standard treatment for infective endocarditis is 6 weeks of intravenous antibiotics, However, this is not always possible for individuals who inject drugs, because they are more likely to leave the hospital before treatment is completed.

Recent research shows that other treatment options, including shorter intravenous antibiotic regimens, followed by oral antibiotic or only the use of oral antibiotics, could help treat this population, according to the statement.

Additionally, the writing committee emphasized the importance of early management of substance use disorder at the time of hospitalization for infective endocarditis, including medications to help reduce opioid-related withdrawal symptoms, which can help minimize the chances of early discontinuation of treatment.

They also advise support for improved public education about safer injection practices and a list of items for a harm reduction kit, including bandages, sterile water, and tourniquets, to give to individuals who inject drugs.

Individuals with endocarditis related to injection drug use may experience financial challenges to access treatment, especially if they do not have health insurance or stable housing.

These individuals may also have underlying health conditions that could contribute to addiction, so treatment for both infective endocarditis and substance use disorder are important, according to the writing committee.

Furthermore, the team stressed that individuals with infective endocarditis who inject drugs should be considered for heart valve repair or replacement surgery, regardless of drug use.

“There’s no evidence that indications for valve surgery are different for [individuals] who inject drugs compared to those who don’t. However, some treatment centers don’t offer surgery, especially if the patient currently injects drugs or has had a previous valve surgery,” DeSimone said.

“Those who develop infective endocarditis require complex care delivered by professionals who look beyond stigma and bias to provide optimal and equitable care,” he said.

More studies are needed to evaluate the effectiveness and safety of medications used to treated infective endocarditis for those who inject drugs, DeSimone said.

Reference

Addiction management is key to treating heart infection in people who inject drugs. News release. EurekAlert. August 31, 2022. Accessed August 31, 2022. https://www.eurekalert.org/news-releases/962952