Abstract 255: Patterns of Addiction Treatment for Patients Undergoing Cardiac Surgery for Infective Endocarditis Associated with Intravenous Drug Use
Authors: Nguemeni Tiako Max Jordan , Hong Seong , Bin Mahmood Syed Usman , Darr Umer , Mangi Abeel , Jutthani-Mehta Manisha , Geirsson Arnar 
Published: April 2019

Introduction:
Over the last decade, the U.S. has seen an increase in the number of infective endocarditis (IE) cases requiring surgical intervention. Infective endocarditis is often caused by intravenous drug use (IVDU). Given the complexity of these cases, the association with IVDU and the current opioid epidemic, we sought to characterize the nature of addiction interventions for these patients peri-operatively.

Methods:
This is a retrospective review of patients who underwent cardiac surgery for IE associated with a history of IVDU from 2009 to 2016 at a tertiary care center in New Haven, Connecticut. Data was collected including which drugs patients used, consultations by social work and psychiatry, initiation of medical therapy for addiction (methadone, buprenorphine, naltrexone), harm reduction initiative (naloxone), and evidence of enrollment in a drug rehabilitation program in the post-operative period.

Results:
This study observed 56 patients with a history of IVDU who underwent surgical intervention for IE. Thirty patients had active drug use at the time of their surgery, and the rest was labeled as having a history of IVDU. Among the 30, 22 used at least heroin, including 8 who used heroin and cocaine, and 5 who used heroin along with 2 or more other drugs (benzodiazepine, PCP, street suboxone, cocaine, Percocet, marijuana). In terms of psychosocial interventions, 41 (73.2%) were seen by a social worker, and 38 (67.9%) were seen by a psychiatrist during their hospitalization. Fourteen patients (25%) were neither seen by a social worker nor a psychiatrist. Medical therapy was defined as the administration of methadone, buprenorphine, naltrexone or naloxone during the hospitalization. Twenty-one patients (37.5%) were prescribed methadone, 6 patients (10.7%) were prescribed buprenorphine, 14 (25%) were prescribed naloxone, and 1 (0.02%) was prescribed naltrexone. Twenty-six patients (46.4%) were not prescribed any of the aforementioned medications. A total of 15 patients went to a drug rehabilitation program (26.8%) upon discharge, 13 of whom had been seen by a social worker (86.7%), and 8 by a psychiatrist (53.3%). Conversely, among those who did not go to a rehabilitation program, only 23% were seen by a psychiatrist, and 67.5% were seen by a social worker. The programs described included 12-step group rehabilitation, narcotics anonymous and adherence to daily methadone programs.

Conclusion:
This study highlights the inconsistency in addiction interventions in patients with IVDU-associated IE. Some patients receive medical therapy and are consulted upon for their psychosocial factors, but this practice is inconsistent. Given than recidivism (relapse in drug use or recurrent endocarditis) is the leading cause of death in this population, standardized protocols for addiction interventions in these patients are of utmost importance with the aim to improve long-term survival.