Drug-use associated infective endocarditis: Post-hospitalization outcomes and patient treatment preferences

PROJECT SUMMARY/ABSTRACT
Hospitalizations for drug use-associated infective endocarditis (DUA-IE), an infection of the heart valves from
injecting drugs, have increased sharply as a consequence of the opioid epidemic. DUA-IE is a severe disease
that poses substantial morbidity to patients and burden to hospitals and insurance payers. Treatment typically
requires long hospitalizations, six weeks of intravenous antibiotics and often includes surgical heart valve
replacement. The post-hospitalization course of patients with DUA-IE has not been well-studied. During
treatment, many patients’ drug use disorders (DUDs) remain unaddressed, despite their central role in causing
DUA-IE, leaving patients vulnerable to ongoing drug-related risks such as overdose and repeat DUA-IE.
Understanding how to address DUDs for hospitalized patients with DUA-IE, particularly in areas with limited
treatment resources, is critically important. The overall objectives of this work are to characterize DUA-IE
patients’ post-discharge course to understand the scope and timing of negative clinical outcomes, and to explore
DUA-IE patients’ perspectives to identify strategies to foster engagement in DUD and infectious disease care. In
North Carolina, a Medicaid non-expansion state, we will evaluate three research aims: (1) Estimate incidence
rates of and risk factors for adverse outcomes following hospitalization for DUA-IE including: drug overdose,
readmission, reoperation, and all-cause mortality; (2) Explore knowledge, preferences, and perceptions of DUA-
IE risk, post-hospitalization drug use, DUD treatment, and antibiotic options among hospitalized DUA-IE patients;
and (3) Pilot a multicenter survey characterizing DUA-IE patients’ knowledge, preferences, and perceptions of
DUA-IE and DUD, access to care, and treatment preferences. Completion of these aims aligns with a training
objective to obtain skills across five specific domains: (1) epidemiologic analysis of administrative datasets, (2)
exploratory qualitative research, (3) developing and analyzing questionnaires, (4) collaborative, management
and project development, and (5) the responsible conduct of human subjects research. This training will be
accomplished through coursework, one-on-one instruction and guidance from a diverse group of mentors and
advisors from across the University of North Carolina, Duke University and the North Carolina Division of Public
Health, including experts in health services research for infectious diseases, DUD care, multisite studies of
infective endocarditis and behavioral health. Completion of the research and training aims represent short-term
career goals, but they will also form a foundation for my future academic endeavors. My long-term goal is to
become an independent investigator with expertise in the infectious complications of drug use, and to be
prepared to implement interventions and to answer new epidemiologic and behavioral questions that arise. This
research and training plan is foundational to the future implementation and evaluation of an inpatient intervention
to enhance post-discharge outcomes for DUA-IE, which I will propose in an R01 towards the end of the award
as I transition to research and funding independence.