Risk of endocarditis more than 3x higher after COVID-19 infection in patients with cocaine, opioid abuse disorders

CLEVELAND–People diagnosed with cocaine- and opioid-use disorders are more susceptible to developing endocarditis, a condition that damages the lining of the heart valves and chambers, according to research from the Case Western Reserve University (CWRU) School of Medicine and National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.

The research team found that patients diagnosed with cocaine (CocaineUD)- or opioid-use disorder (OUD) who were infected with SARS-CoV-2 experienced an incident rate of endocarditis three to eight times higher than those without the disorders, showing that endocarditis is a significant health concern for people using cocaine or opioids.

About three million people in the U.S. meet the criteria for OUD, according to the National Institutes of Health (NIH), while roughly 75% of the more than 91,000 drug overdose deaths in 2020 involved an opioid, reported the Centers for Disease Control and Prevention (CDC).

The new research findings were published Dec. 12 in the journal Molecular Psychiatry. The research team believes the findings highlight the need for endocarditis screenings in those diagnosed with OUD or CocaineUD and infected with COVID-19.

“Endocarditis is a serious and potentially fatal complication of intravenous drug use, and our study shows that patients with opioid- or cocaine-use disorder are at even higher risk for endocarditis if they contract COVID-19,” said Pamela Davis, Distinguished University Professor and The Arline H. and Curtis F. Garvin Research Professor at the School of Medicine. “It is essential to monitor patients with these underlying disorders carefully for endocarditis if they become infected with SARS-CoV2.”  

Endocarditis can be fatal without treatment and, according to researchers, the condition is increasing, driven partly by the rise in intravenous opioid and stimulant use in the U.S. Intravenous drug use involves injecting a substance into a vein.

Study findings

The researchers analyzed unidentified electronic health records of more than 109 million patients in the U.S., including more than 736,000 with OUD and more than 379,000 with a diagnosis of CocaineUD.

The data showed the number of people with endocarditis and OUD or CocaineUD significantly increased from 2011-22, with a rapid increase from 2021-22. The data was statistically score-matched to account for demographics, comorbidities, medications, medical procedures and socioeconomic determinants of health.

Association of COVID-19 with endocarditis in patients with OUD

• Overall risk for new diagnosis of endocarditis was 1.18% for people with OUD who contracted COVID-19, compared to .55% in those with no COVID-19 diagnosis;

Association of COVID-19 with endocarditis in patients with CocaineUD

• Overall risk for new diagnosis of endocarditis was 1.14% for people with CocaineUD who also contracted COVID-19, compared to .52% in those with no COVID-19 diagnosis.

Among patients with opioid or cocaine use disorders, 180-day hospitalization risk following a new diagnosis of endocarditis was 67.5% in patients with COVID-19, compared to 58.7% in patients without COVID-19. The 180-day mortality risk following new diagnosis of endocarditis was 9.2% in patients with COVID-19, compared to 8% in patients without COVID-19.

The rapid acceleration in the incidence rate of endocarditis during the pandemic when compared to prepandemic shows that COVID-19 infection likely further increased the risk of endocarditis among patients with OUD or CocaineUD, said Rong Xu, professor of Biomedical Informatics and director of the Center for AI in Drug Discovery at the School of Medicine.

Xu explained future studies are warranted to further understand how SARS-CoV-2 infection damages the heart and vascular endothelium in people with CocaineUD or OUD. (Methamphetamine use was not incorporated in the study as it is not a medically coded diagnosis.)

Study authors included: Davis, Xu, Nathan Berger, David Kaelber and Lindsey Wang from Case Western Reserve, and Nora Volkow from NIDA.

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This research is supported by the National Institutes of Health under grant numbers AA029831, AG057557, AG061388, AG062272, AG076649, CA221718, CA043703, CA233216, and TR002548. The content presented in this release is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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