Addiction treatment a life-saver for hospital patients with heart infections: Study

Hospitals can save lives by providing addiction treatment to patients suffering heart infections, a first-of-its-kind study in London and Regina has concluded.

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The same study found that women, and urban women in particular, who inject drugs die at a higher rate than men from the heart valve infection called endocarditis.

Pregnant women and their babies are also at a particularly high risk of death, the study found.

“It’s a real call to action,” co-author Dr. Michael Silverman of London said. “One, we need to have addiction services in hospital. Two, we need to be supporting women who inject drugs, and particularly those living in urban centers. We’ve got to offer contraceptive advice and contraceptive services for these women because they have such a high mortality when they get pregnant, and the babies do so badly.”

Silverman is an infectious disease researcher at St. Joseph’s Health Care London and a scientist at Lawson Research Institute in London.

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He and a group of University of Saskatchewan researchers examined hospital and post-hospital records of 764 people with endocarditis from 2007 to 2023 at St. Joseph’s Health Care and London Health Sciences Center in London, and in two Regina hospitals.

People who inject drugs have a high risk of getting endocarditis for many reasons: by using gear and drugs that contain bacteria, by using drugs while living homeless or in squalid conditions and by crushing pills that still leave particles that can scrape heart valves.

“Bits of infected material build up on your valve. They form a little bit of a clot, and those pieces then can break off and go to your brain and give you a stroke, go to your spinal cord and make you paralyzed, cause severe bone and joint infections. It can be lethal,” Silverman explained.

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Fifty six percent of all the patients with endocarditis who were admitted to hospital during the study were people who injected drugs.

Their mortality rate after five years was 49 per cent, with most deaths from endocarditis in the first year.

“That is really remarkably high and tragic, particularly when you consider that the average age for the women was only 31 and the average age for the men was 38,” Silverman said.

But getting addiction treatment, including social service help and opioid replacement therapy, while in hospital dramatically improved outcomes, he said.

Researchers were able to determine that by studying outcomes in London and Regina hospitals, where patients are provided addiction treatment.

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“You were 61 per cent less likely to die, to be dead at five years, if you were offered treatment in hospital than if you just were referred to have treatment after you left. So it made a real difference,” Silverman said.

One likely reason: Patients who withdraw in hospital under medical care with social service supports already in place are better able to manage their lives and health upon discharge than those battling withdrawal and addiction by themselves on the streets, he said.

“This should be offered more broadly across Canada and worldwide, because we think that this makes a real difference.”

The study also calls for action on helping women. Slightly more than half of the endocarditis patients were women, even though only a third of people who inject drugs in Canada and the US are women.

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“We think that there are a couple of things at play,” Silverman said.

Marginalized, manipulated and without power in many relationships, women are often the last ones to get access to drugs being shared, and so are using equipment more likely to contain bacteria, he said.

With smaller and sometimes harder to find veins, women can rely on others to inject them and lose control over their own precautions, Silverman said.

Somewhat surprising at first glance, women in urban centers were 2.7 times more likely to die than women in rural areas.

That contradictions perceptions that “if you live in a rural area, it’s more isolated and you can’t get medical care. When you live in an urban area, you live closer to the hospital,” Silverman said.

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But “for these women, the urban area is a very risky place. The sex trade and its associated violence is also a huge issue in urban areas, and many of these women are trafficked. Homelessness is more common in the urban setting. In rural areas, people are more likely to be living with family or friends.”

Five per hundred of the women were pregnant and the mortality rate of the mothers and babies was “very high,” Silverman said.

Three of the 11 women in the study died, five pregnancies were terminated (two by miscarriage) and of those babies born, two were premature and one ended up in ICU, researchers say.

London and Regina have health care networks that allow researchers to study what happens to patients after they leave one hospital, Silverman noted.

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“This is the first study that’s ever been done that looked at five-year outcomes, and the first time that it’s been identified that women are more at risk. And the first time that it’s been shown that inpatient addiction services can reduce long-term mortality, and therefore it’s a real call to action.”

The paper was co-authored by University of Saskatchewan researchers doctors Stuart Skinner and Cara Spence, and Janice Adams. The study was funded by St. Joseph’s Health Care Foundation.

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