Contributors to Hospitalized Infective Endocarditis Outcomes Among Patients With Substance Use

Background: Patients with substance use (SU) diagnosed with infective endocarditis (IE) have high rates of discharge against medical advice (DAMA) and 30-day readmission. Objective: Evaluate contributors associated with DAMA and 30-day readmission among patients with SU and IE. Methods: This retrospective chart review included patients >18 years, admitted to one hospital in the Northeastern, United States for SU and IE from January 2018 to December 2020. Patient demographic and clinical characteristics and their association with DAMA and 30-day readmission were summarized using descriptive statistics and Logistic Regression. Results: Of the 144 patients, 60.4% used more than one substance, 38.2% experienced DAMA, and 61.1% were readmitted within 30 days. Age (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.92–0.98), Length of stay (LOS) (OR, 0.95; 95% CI, 0.93–0.98), Medicaid (OR, 2.98; 95% CI, 1.45–6.16), Medicare (OR, 0.29; 95% CI, 0.10–0.81), opioid usage (OR, 2.29; 95% CI, 1.01–5.16), and stimulant usage (OR, 2.89; 95% CI, 1.43–5.84) were all significantly associated with DAMA but not with 30-day readmission. Conclusions: Additional investigations of factors associated with DAMA and 30-day readmission are needed to help improve practices and reduce negative outcomes. Implications for Nursing: Multiple factors can affect patient adherence to treatment in this high-risk population. Nursing directly impacts the identification and addressing of unique SU IE patient needs to optimize treatment goals.