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AHA Guidance on Infectious Endocarditis Due to Injectable Drug Use

AHA Guidance on Infectious Endocarditis Due to Injectable Drug Use

 


Prompted by an ‘unprecedented’ increase in incidence Infectious endocarditis The American Heart Association (AHA) has issued a scientific statement dedicated exclusively to this difficult patient population.

This statement focuses in greater detail on the management of this unique population of infective endocarditis (IE) than has been provided in previous AHA IE publications.

This statement emphasizes that the management of IE in injecting drug users is complex and requires a unique multidisciplinary approach that includes physician consultation. Addiction Expert.

the statement is publish online August 31st circulation.

Poor long-term prognosis

In the United States from 2002 to 2016, the proportion of hospitalized patients with IE was Use of injectable drugs doubles 8% to about 16%.

The long-term prognosis for this population “is currently dire for this relatively young group of individuals,” said Daniel C. DeSimone, M.D., Ph.D., of the Mayo Clinic in Rochester, Minnesota, in a news release.

To improve outcomes, the writing group is a multidisciplinary team that includes cardiologists, cardiac surgeons, infectious disease specialists, addiction medicine or psychiatry specialists, pharmacists, social workers, and nurse specialists. Advice on care approaches.

Specialist nurses can coordinate care from the initial IE admission to outpatient and community care to support substance use disorders.

“Clinical teams must recognize that substance use disorders are treatable, chronic, relapsing medical conditions, and that many people can go into sustained remission, especially if they receive effective treatment. We have to,” the writing group stressed.

Not all patients with injectable drug-related IE have opioid addictionfor those who do, the “best practice” is to provide buprenorphine Also methadone “As soon as possible,” they advise, when a patient comes to the hospital.

antibacterial therapy

The writing group says it is “reasonable” to offer people with injectable drug-related IE the standard of care for IE, which is six weeks of intravenous antibiotics. recognizes that this is often not feasible in this patient population, and there is growing evidence that partial intravenous therapy followed by oral antibiotic therapy to complete a total of 6 weeks is a viable option. said that

They also emphasize the “critical” importance of preventative measures in people who inject drugs that successfully treat the first attack of IE. use of injectable drugs continues.

The writing group also emphasizes that heart disease should be considered in patients with IE who inject drugs. valve repair or replacement surgery if valve surgery is indicated, regardless of current drug use.

“Although there is no evidence that valve surgery is indicated differently for people who inject drugs versus those who do not, some treatment centers do not offer surgery, especially if the patient is currently injecting drugs. Or if you’ve had valve surgery before,” DeSimone said in a release.

“People who develop infective endocarditis require complex care delivered by professionals who transcend stigma and prejudice to provide optimal and equitable care,” adds DeSimone.

The writing group acknowledges that while expertise in addiction medicine and addiction psychiatry is important for managing IE in injecting drug users, these specific resources are not currently widely available. I’m here.

They want the health system to attract individuals undergoing addiction training and support addiction medical counseling services, especially at centers where drug use-related IE is common and is expected to continue to grow. I am asking for

This AHA Scientific Statement is for AHA Rheumatic Fever, Endocarditis and Kawasaki disease lifelong conference committee congenital heart disease Heart Health in Youth; Cardiovascular Surgery Council and anesthesia; Cardiovascular Council and stroke Nursing; Clinical Cardiology Council; and Council peripheral vascular disease.

There was no commercial funding for this study. DeSimone has no relevant disclosures.

circulation. Published online on August 31, 2022. Overview

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