Trends in Infective Endocarditis Burden in Context of the Opioid Epidemic

endocarditis, infective endocarditis
The in-hospital mortality for native valve infective endocarditis has decreased between 2002 and 2016.

The in-hospital mortality for native valve infective endocarditis has decreased between 2002 and 2016, according to a study published in the American Journal of Cardiology.

The investigators used 2002 to 2016 data from the National Inpatient Sample, which they divided into 5-year periods (2002-2006; 2007-201; and 2012-2016). The study’s primary outcomes were trends of in-hospital mortality, mean length and mean cost of stay, and inpatient procedures. 

A total of 523,432 encounters were identified for this period in the database. The number of infective endocarditis hospitalizations increased from 155,151 between 2002 and 2006 to 195,300 between 2012 and 2016 (P <.01). Risk-adjusted in-hospital mortality decreased from 16.7% in 2002 to 9.7% in 2016 (P <.01). In-hospital mortality was found to be associated with age (odds ratio [OR], 1.021; 95% CI, 1.020-1.022), female gender (OR, 1.07; 95% CI, 1.05-1.09), black ethnicity (OR, 1.28; 95% CI, 1.24-1.31) or Hispanic ethnicity (OR, 1.15; 95% CI, 1.11-1.19), and several comorbidities including congestive heart failure (P <.01 for all).

The mean length of stay decreased from 17.4 days in 2002 to 13.4 days in 2016 (P <.01). However, the mean cost of stay increased from $112,702 in 2002 to $164,767 in 2016 (P <.01). The increase in cost was likely due to an increase in the frequency of septic shock (5.7% in 2002 to 17.1% in 2016), ventilator use (13.6% in 2002 to 17.5% in 2016), and valve replacement (10.2% in 2002 to 13.4% in 2016; P <.01 for all).

Routine discharges decreased from 50.7% for the 2002 to 2006 period to 45.4% for the 2012 to 2016 period (P <.01), and discharges to long-term care facilities increased from 36.0% to 37.8%, respectively (P <.01).

The investigators hypothesized that the rising incidence of native valve infective endocarditis is tied to comorbidities associated with the opioid crisis. Hospitalization for infective endocarditis increased in patients with a history of drug abuse, from 9.7% in 2002 to 23.1% in 2016 (P <.01). Individuals who use vs did not use drugs had a shorter length of hospital stay but higher costs of stay.

Study limitations include its retrospective nature which prevents the identification of causal relationships between observed associations.

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“[A]lthough mortality and length of stay have been on the decline in [patients with infective endocarditis], the average cost of hospital stay has increased,” the study authors concluded. “This trend was uniform in patients with drug abuse history even though their prevalence is on the rise in [the United States].”


Khan MZ, Munir MB, Khan MU, Khan SU, Benjamin MM, Balla S. Contemporary trends in native valve infective endocarditis in United States (from the National Inpatient Sample Database) [published online Mar 16, 2020]. Am J Cardiol. doi:10.1016/j.amjcard.2020.02.035

This article originally appeared on The Cardiology Advisor