Death rates from rare heart condition surging among young Americans

Researchers warn that opioid epidemic is fueling lethal cases of infective endocarditis in younger adults.

DALLAS — A troubling trend in Americans’ heart health is emerging, and doctors are aiming to bring more awareness to the problem. While death rates from infective endocarditis have generally declined across the U.S. over the past two decades, they have alarmingly increased among young adults aged 25 to 44. This research, published in the Journal of the American Heart Association, underscores a public health issue that intersects with the ongoing opioid crisis.

Infective endocarditis, often referred to as bacterial endocarditis, is a rare but serious condition where bacteria enter the bloodstream and infect the heart lining, valves, or blood vessels. It poses a higher risk to individuals with heart valve abnormalities, previous valve surgeries, artificial valves, congenital heart defects, or a history of the disease. If left untreated, it can lead to severe complications, including heart failure and life-threatening infections. Alarmingly, it can also be a complication arising from the injection of illicit drugs.

Infective Endocarditis Death Rates By Age

The study was conducted Dr. Sudarshan Balla, an associate professor of medicine at the West Virginia University Heart and Vascular Institute. He points out the concerning rise in death rates among young adults, speculating a strong link to the opioid crisis affecting several states. “Our study findings raise a public health concern, especially since the deaths in younger age groups are on the rise,” he says in a statement. “We speculate that this acceleration was likely, in the most part, due to the opioid crisis that has engulfed several states and involved principally younger adults.”

The study utilized the Centers for Disease Control and Prevention’s Multiple Cause of Death dataset to analyze national trends and disparities across different demographics from 1999 to 2020. Despite the decline in infective endocarditis death rates overall in the U.S., the data shows a 5% average annual increase in death rates among young adults aged 25-34, and more than 2% for the 35-44 age group.

Stagnant rates were seen in the 45-54 age group, while a decline was seen in adults over 55.

Additionally, the study analyzed state-level trends in death rates, providing insights into regional variations. This approach allowed the researchers to uncover the disproportionate impact of infective endocarditis in certain states and among specific age groups, linking these trends to broader public health issues like the opioid crisis.

Kentucky, Tennessee, and West Virginia exhibited a particularly pronounced increase in death rates due to infective endocarditis. These states, heavily impacted by the opioid epidemic, have seen an increase in injection drug use–related infective endocarditis cases.

The Opioid Crisis Connection

Study results indicate a potential connection between the increase in infective endocarditis deaths among young adults and the opioid epidemic. Substance use disorder, often associated with opioid abuse, emerged as a significant factor in the study, particularly in the states most affected.

The findings of this study are a wake-up call, emphasizing the need for targeted public health interventions, especially in states heavily affected by the opioid crisis. Dr. Balla stresses the need for comprehensive care plans that include screening and treatment for substance use disorder for those treated for infective endocarditis. He also highlights the ongoing efforts in some states to implement harm reduction programs aimed at mitigating the risks associated with intravenous drug use, such as the spread of infectious diseases.

The researchers acknowledge certain limitations due to the reliance on death certificate data, which can sometimes contain inaccuracies. They emphasize the need for further investigation to fully understand the reasons behind these trends among young adults and in specific states.

How To Prevent Infective Endocarditis

Preventing infective endocarditis involves good hygiene, managing existing conditions, and following specific precautions for at-risk procedures. Here are some key tips:

Oral hygiene:

• Maintain excellent oral health: Brush twice daily, floss regularly, and schedule dental checkups every six months. This reduces bacteria in your mouth, minimizing the risk of it entering your bloodstream through gum disease or tooth abscesses.
• Treat dental infections promptly: Address gingivitis, cavities, and other dental issues quickly to prevent bacteria from entering your bloodstream.

General hygiene:

• Practice good handwashing: Wash your hands frequently with soap and water, especially before and after medical procedures, caring for wounds, or touching your face. This helps prevent bacteria from spreading.
• Take care of your skin: Treat cuts, scrapes, and wounds promptly to prevent infection. If you have a chronic skin condition, manage it effectively to lower the risk of bacteria entering your bloodstream.

Managing existing conditions:

• Control heart valve problems: If you have existing heart valve issues, regular monitoring and timely treatment are crucial. Address leaky valves or valve replacements as needed to minimize the risk of bacteria attaching to them.
• Treat ongoing infections: Manage any current infections diligently with antibiotics and follow your doctor’s advice to control the spread of bacteria.

Precautions for at-risk procedures:

• Follow antibiotic prophylaxis guidelines: If you have certain heart conditions, your doctor may recommend taking antibiotics before specific procedures like dental work, urinary tract surgery, or certain respiratory procedures. This helps prevent bacteria from entering your bloodstream during the procedure.
• Talk to your doctor before having piercings or tattoos: If you have a heart condition, discuss piercings or tattoos with your doctor beforehand, as these procedures can introduce bacteria into your bloodstream.

And of course, maintaining good general health goes a long way. Eating a balanced diet, exercising regularly, and getting enough sleep all contribute to a strong immune system, which can help fight off infections. Be cautious about activities that increase your risk of skin or mucous membrane tears, such as sharing needles or using certain types of body-piercing jewelry. As this study shows, substance use certainly can play a key role in the condition.

Remember, while these tips can help prevent infective endocarditis, they are not guaranteed to eliminate the risk entirely. If you experience any symptoms of infective endocarditis, such as fever, chills, fatigue, new heart murmur, or unexplained skin changes, seek immediate medical attention.

It’s important to note that these are general tips, and the specific recommendations for preventing infective endocarditis may vary depending on your individual risk factors and medical history. Always consult your doctor for personalized advice on how to best protect yourself from this serious condition.