Impact of a multidisciplinary endocarditis evaluation team for opioid use associated infective endocarditis.

Abstract

Infective endocarditis (IE) related to opioid use disorder (OUD) and injection substance use is on the rise. Multidisciplinary care is recommended for individuals with substance-related IE, but little is known about the impact of this care. A retrospective cohort study to evaluate the impact of a multidisciplinary endocarditis evaluation team (MEET) on outcomes for patients with IE and specifically OUD-related IE. The MEET is a clinical team from multiple specialities that collaboratively facilitates optimal hospital-based treatment, including addiction-related treatment. The study compares a historical control group of hospitalized adults with OUD and OUD-related IE who did not receive the MEET intervention (treatment as usual [TAU] group) with a group of hospitalized adults with OUD and OUD-related IE who received the MEET intervention. The primary outcome is receipt of medication for OUD (MOUD) at hospital discharge. Secondary outcomes are receipt of OUD treatment referral, 30-day ED visits, 30-day hospital re-admission, all-cause mortality, recurrence of IE, and repeat IE-related surgery. Nearly all patients in the MEET group (n = 68) were discharged on MOUD compared with the TAU group (n = 58) (98.5% vs. 56.9%) and received a referral for OUD treatment (97.1% vs. 74.1%). We were unable to detect a difference in 30-day ED visits and hospital readmissions, all-cause mortality, recurrent IE, and repeat IE-related surgery. A multidisciplinary intervention was associated with improved OUD-related outcomes. No change was observed in health care utilization, all-cause mortality, or other IE-related outcomes.