Dr. Michael Silverman, Dr. Sharon Koivu, and Dr. Laura Rodger. Photo courtesy of Lawson Health Research Institute.

Surgery, counselling ups survival rate for people who inject drugs

People suffering from a heart valve infection, who also use injection drugs, are more likely to survive if treated with a combination of surgery and addictions counselling, according to a new London-based study.

Researchers at Lawson Health Research Institute and Western University examined patients with endocarditis, a heart valve infection that is commonly contracted through injection drug use. Using anonymous patient data from 2007 to 2016 from the London Health Sciences Centre (LHSC) and St. Joseph’s Health Care London, researchers found that patients with first-episode endocarditis who received surgery experienced a 56 per cent reduction in mortality.

While additional studies are needed, the findings show cardiac surgery should be considered a viable treatment option in carefully selected patients, not just those who are severely ill.

“In the past, many centres have not performed cardiac surgery in patients who inject drugs due to concerns about poor outcomes. Continued injection drug use was viewed as a risk for reinfection,” said study co-author Dr. Michael Silverman, Lawson scientist and chief of infectious diseases for Western’s Schulich School of Medicine & Dentistry, LHSC and St. Joseph’s. “Our study challenges those beliefs. It shows that when we account for the severity of a patient’s illness, they’re more likely to survive with surgery.”

In-hospital addictions counselling was also a major factor in improved survival rates of those who use injection drugs with first-episode endocarditis. A consultant would meet with patients to provide education on risks for infection, harm reduction strategies, and support towards addictions recovery, including referral to community supports as part of the counselling. That led to a 72 per cent reduction in mortality, researchers found.

“Education and support for these patients is critical. The majority of the patients I see don’t understand what they’re doing to cause an infection and may be highly motivated to undertake a lifestyle change,” said study co-author Dr. Sharon Koivu, Lawson scientist and palliative-care physician at LHSC. “This study shows the importance of working with patients towards harm reduction and addiction recovery while they’re still being treated in hospital.”

People suffering from an acute infection aren’t typically referred to addictions counselling while still in hospital because it is believed they are too ill to undergo that type of therapy. Instead, they are often referred for counselling after they are discharged.

London has a higher rate of patients who inject drugs suffering from endocarditis than other regions. Injection drug users account for 55 per cent of all heart valve infections in London. Researchers are currently conducting a number of additional studies to address the issues including best strategies for treatment, such as antibiotic and surgical interventions.

“We don’t often get a chance to look at large numbers of this particular patient population but there is a plethora of local data available,” said study co-author Dr. Laura Rodger, Schulich Medicine & Dentistry and LHSC resident physician. “Our team wants to bring meaning to that data by asking the right questions to ultimately improve patient outcomes.”

The study, titled Clinical Characteristics and Factors Associated with Mortality in First-Episode Infective Endocarditis Among Persons Who Inject Drugs, was recently published in the JAMA Network OPEN.