A new statement from the American Heart Association emphasizes drug withdrawal and special care teams to prevent endocarditis in these individuals.
According to a scientific statement from the American Heart Association (AHA) published in Circulation.
In the statement, the AHA emphasized the need for specialized care for those individuals, a population it has not addressed in its previous guidelines.
“Advances in our understanding of the unique challenges for the treatment of infectious endocarditis in [individuals] injecting drugs compared to those who develop the infection as a result of other health conditions led to this statement,” said 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 disorders. Without a multidisciplinary approach, these individuals are not only more likely to develop infective endocarditis and other serious infections, but also have a relapse of the infection,” DeSimone said.
The writing committee recommended that a multidisciplinary team approach can improve the long-term prognosis for the population. The team should include addiction medicine or substance abuse specialists, cardiologists, cardiac surgeons, infectious disease specialists, nurse practitioners, pharmacists, and social workers.
The nurse practitioners can provide coordinated care from initial hospitalization to outpatient and community care support for substance use disorders, she added.
The standard treatment for infectious endocarditis is 6 weeks of intravenous antibiotics. However, this is not always possible for individuals who inject drugs, as they are more likely to leave the hospital before the treatment is completed.
Recent research shows that other treatment options, including shorter intravenous antibiotic regimens followed by oral antibiotics or the use of oral antibiotics alone, may help treat this population, according to the statement.
In addition, the writing committee emphasized the importance of early treatment of substance use disorders at the time of hospitalization for infective endocarditis, including medications to help reduce opioid-related withdrawal symptoms, which may help minimize the likelihood of early treatment discontinuation.
They also recommend support for improved public education about safer injection practices and a list of harm reduction kit items, including bandages, sterile water and tourniquets, to give to individuals who inject drugs.
Individuals with endocarditis related to injection drug use may face financial difficulties accessing treatment, especially if they do not have health insurance or stable housing.
These individuals may also have underlying health conditions that can contribute to addiction, so treatment for both infective endocarditis and substance use disorders is important, the writing committee said.
In addition, the team emphasized that individuals with infective endocarditis who inject drugs should be considered for heart valve repair or replacement surgery, regardless of drug use.
“There is no evidence that indications for valve surgery are different for [individuals] who inject drugs compared to those who don’t. However, some treatment centers do not offer surgery, especially if the patient is currently injecting medications or has had previous valve surgery,” DeSimone said.
“Those who develop infective endocarditis require complex care delivered by professionals who look beyond stigma and prejudice to provide optimal and equitable care,” he said.
More studies are needed to evaluate the effectiveness and safety of medications used to treat infectious endocarditis for those who inject drugs, DeSimone said.
Addiction management is key to treating heart infections in people who inject drugs. news item. EurekAlert. August 31, 2022. Accessed August 31, 2022. https://www.eurekalert.org/news-releases/962952