Surgery, in-hospital counselling improve odds for drug users with heart infection: study

A new study out of Western University and Lawson Health Research Institute shows that people who inject drugs are more likely to survive a heart valve complication if they receive surgery and get addictions counselling in hospital.

“In the past, many centres have not performed cardiac surgery in patients who inject drugs due to concerns about poor outcomes,” said Dr. Michael Silverman,  one of the study’s co-authors.

London has some of the highest rates of injection drug use and overdose deaths in the country. In London, 55 per cent of people who have endocarditis, a heart valve infection, are injection drug users.

“Continued injection drug use was viewed as a risk for reinfection,” said Silverman, the lead of infectious diseases at the Schulich School of Medicine and Dentistry, London Health Sciences Centre, and St. Josephs. But the study he co-wrote with Dr. Sharon Koivu challenges those beliefs and shows that people who inject drugs have 56 per cent less chance of dying if they undergo cardiac surgery.

“When we account for the severity of a patient’s illness, they’re more likely to survive with surgery.”

The study also shows that if patients are introduced to addictions counselling while they’re still in hospital, rather than being referred to counselling after they are discharged, their chance of dying is reduced by 72 per cent.

“Education and support for those these patients is critical,” said Koivu.

The usual approach is to connect patients to counselling after they leave hospital because they’re commonly believed to be too ill to receive addictions therapy. But Koivu believes that’s not true, and is emphasizing the importance of teaching harm reduction while they’re still in hospital.

“The majority of the patients I see don’t understand what they’re doing to cause an infection and may be highly motivated to make a lifestyle change,” she said.

The Lawson scientist, who doubles as an associate professor at Schulich Medicine and Dentistry and palliative-care physician with London Health Sciences Centre, is emphasizing the importance of teaching patients about harm reduction while they’re still in hospital.

The project looked at anonymous patient data from 2007 to 2016 at both London Health Sciences Centre and St. Joseph’s Health Care London. Of the 370 patients with first episode endocarditis, 202 were persons who inject drugs.

Of those 202 persons, 39 had cardiac surgery and 40 started addictions counselling while in hospital. Researchers acknowledge that more studies are necessary, but say cardiac surgery should be considered a viable treatment option for carefully selected patients.

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