Abstract 8: Increasing Rate of Stroke From Infective Endocarditis Related to Opioid Abuse in the U.S.

Background: There has been a recent sharp rise in opioid-related deaths in the U.S. Intravenous opioid use can lead to infective endocarditis which can result in stroke. There are scant data on recent trends in this neurological complication of opioid abuse. We investigated whether increasing opioid abuse has led to a higher incidence of stroke from opioid-related endocarditis. Methods: We used the 1993 to 2015 releases of the National Inpatient Sample and validated International Classification of Diseases, 9 th Revision, Clinical Modification codes to identify patients hospitalized with the combination of opioid abuse, infective endocarditis, and stroke (defined as ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage). Survey weights provided by the NIS were used to calculate nationally representative estimates, and population estimates from the U.S. census were used to calculate age- and sex-adjusted annual hospitalization rates per 10 million person-years. Joinpoint regression was used to assess trends. Results: From 1993 through 2015, 5,283 patients were hospitalized with stroke from endocarditis secondary to opioid abuse. Across this period, the incidence of such strokes increased from 2.4 (95% confidence interval [CI], 0.5 to 4.3) to 18.8 (95% CI, 14.4 to 23.3) hospitalizations per 10 million U.S. residents. Joinpoint regression detected two segments: no significant change in incidence was apparent from 1993 to 2008 (annual percentage change, 2%; 95% CI, -2% to 6%), and then the incidence significantly increased from 2008 to 2015 (annual percentage change, 20%; 95% CI, 11% to 31%) (Figure 1). Conclusions: U.S. hospitalization rates for stroke from opioid-related infective endocarditis were stable for nearly two decades but then sharply increased starting in 2008, coinciding with the emergence of the opioid epidemic.