finding suggests that PWID-IE may have displayed poorer health upon admission than non-PWID-IE . Because differences in short-term outcomes are generally not observed between IE in PWID and other cases of IE , 6 this could suggest that PWID-IE delayed seeking treatment . This emphasizes the importance of destigmatizing SUD , increasing access to recovery services , and providing comprehensive , nonjudgmental care to reduce morbidity and mortality in PWID .
Echocardiographic data suggest that standard IE diagnostic protocol was followed in the majority of cases ( 94.0 %). Initial use of TTE for evaluation of suspected endocarditis did not differ between PWID-IE and non-PWID-IE . Endovascular mass location was primarily right-sided on the tricuspid valve in PWID-IE , which is the most commonly affected valve in PWID- IE . 5 , 6
There are several limitations to this study . Data collected for this study were extracted from electronic medical records . Therefore , we lacked detailed information on each patient ’ s medical history as well as a thorough report of their IE presentation at the time of hospitalization . We could not confirm whether each IE case was associated with IDU . As a result , we created a binary variable for opioid use to analyze our data . Although we were unable to confirm which cases of IE were secondary to IDU , the fact that our demographic data and echocardiographic findings for the PWID-IE group are consistent with what is characteristically observed in PWID with IE supports the validity of our binary opioid use variable .
An additional limitation of this study is that data were obtained solely from CHH . Currently , Huntington is served by two hospitals , CHH and St . Mary ’ s Medical Center ( SMMC ). Many patients with IE are transferred to SMMC from CHH , especially those who require surgical intervention . As such , our analysis of temporal changes in IE in Huntington may not be completely representative of the entire community but does certainly demonstrate the increase in
IE associated with the opioid epidemic . CONCLUSION
The purpose of this study was to determine and describe IE cases by opioid use in our community over time . Our findings reveal that annual admissions for IE at CHH have significantly increased throughout the past decade in the study timeframe , particularly related to opioid use . PWID-IE comprised a majority ( 61.3 %) of total IE cases from 2010 to 2019 . Patient demographics observed in PWID-IE were consistent with national demographic changes in cases of IE in PWID . Echocardiographic data for PWID-IE were also reflective of typical findings of IE in PWID . Based on the rates of HCV and HIV positivity , particularly in PWID-IE , all patients with IE should be tested . Given the significant increase in IE cases in PWID , an emphasis should be placed on destigmatizing SUD and improving access to recovery services to improve health outcomes in this vulnerable population .
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