Mark C. Bates

Infectious diseases like infective endocarditis (IE) may manifest or progress differently between sexes. This study sought to identify the differences in demographic and clinical characteristics among male and female patients with IE. Data were obtained from a newly developed registry comprising all adult patients with first IE admission at the four major tertiary cardiovascular centers in West Virginia, USA during 2014–2018. Patient characteristics were compared between males and females using Chi-square test, Fisher’s exact test, and Wilcoxon rank-sum test. A secondary analysis was restricted to IE patients with drug use only. Among 780 unique patients (390 males, 390 females), significantly more women (a) were younger than males (median age 34.9 vs. 41.4, p < 0.001); (b) reported drug use (77.7% vs. 64.1%, p < 0.001); (c) had tricuspid valve endocarditis (46.4% vs. 30.8%, p < 0.001); and (d) were discharged against medical advice (20% vs. 9.5%, p < 0.001). These differences persisted even within the subgroup of patients with drug use-associated IE. In a state with one of the highest incidences of drug use and overdose deaths, the significantly higher incident IE cases in younger women and higher proportion of women leaving treatment against medical advice are striking. Differential characteristics between male and female patients are important to inform strategies for specialized treatment and care.

Early promising results of renal nerve denervation awakened interest in developing medical device alternatives for patients with resistant hypertension. The subsequent sham-controlled renal nerve d...

The field of transcatheter aortic valve replacement (TAVR) has matured significantly with the outcome and durability data now supporting use in lower‐risk patients. We present a preventable complication from early in our experience (5 years ago) that illustrates the importance of heart team communication and cautious multidiscipline cross‐pollination during the formative years of a program. An 87‐year old female developed confusion, slurred speech and left upper extremity weakness 1 day following TAVR with inconclusive findings on carotid artery duplex and transthoracic echocardiography. Subsequent CT‐scan disclosed a linear, ring‐like, structure in the ascending aorta. The foreign body (FB) was radiolucent and successfully snared via tactile sensation and anatomic landmarks informed by the CT. The extricated FB was the valvuloplasty balloon guard (BG) that was inadvertently introduced into the patient via ascending aortic large sheath access. The failure mode was traced back to the first time use of a new balloon system and unrecognized BG by the surgical physician and technician components of the Heart Team who took the lead role in device insertion due to the open chest access. Subsequently, the heart team made changes to mitigate similar future complications by sharing multidiscipline responsibility for all procedural steps and ensuring the use of all new adjuvant devices are preceded by a procedural pause and team consensus regarding device preparation and use. Additionally, the manufacturer addition of a radiopaque marker or flair on the valvuloplasty BG may be warranted.

Background: The opioid crisis has disproportionally affected Appalachia. One of the potentially lethal and costly complications associated with IV drug use is infective endocarditis (IE). The goal of this study was to assess the trend and costs of substance abuse associated IE admissions in Southern West Virginia.Methods: This is a retrospective analysis of cost, incidence, and geographic patterns of all patients admitted over the last decade with concomitant drug abuse (cocaine, amphetamine, sedative, and other/mixed drug abuse) and IE in the largest tertiary care center for Southern West Virginia. A time series model was used to investigate the effect of drug use on the incidence of IE.Results: A total of 462 patients were hospitalized with IE and concomitant illicit drug use. IE cases increased from 26 admissions in 2008 to 66 in 2015. Patterns of increases in mixed drug use (DRG most often associated with IV drug use in our center) mirrored increases in IE (P = 0.001). From 2008 to 2015, the total hospital charges were $17 306 464 on 462 cases of illicit drug associated IE. Only a fraction of the billed fees (22%) was collected ($3 829 701).Conclusions: The number of patients hospitalized with IE has dramatically increased over the last decade in a pattern that mirrors the increase in mixed drug use. The majority of payers were from underfunded state programs or private pay and thus, only 22% of the hospital charges were paid, leaving a hospital deficit of over $13 476 763 during the study period.

Drug abuse and overdoses are on the rise in West Virginia. Multiple socioeconomic and prescription-prescribing practices influenced this shift. The shifting burden of intravenous drug use to more rural areas has created unique challenges for patient access (medical attention, addiction education, rehabilitation), as well as created an avalanche of additional costs for hospital networks. We analyzed sepsis cases from 2006 to 2015 to investigate whether different types of drug use have increased the odds of developing sepsis as compared to other forms of drug use. To investigate this aspect, the authors examined this relationship by using a logistical regression and a time series analysis of the total cases of drug use and infections. The initial analysis investigated the association between drug use and the number of sepsis cases at Charleston Area Medical Center from 2006 to 2015 using a time series analysis. Results suggest that there are similar relationships between sepsis and sedative usage (p=0.016) and sepsis by mixed/other drug (p= 0.020) use. For logistic regression (n=2284), the infection models of sepsis/skin, endocarditis/skin infection, and osteomyelitis/skin infection showed several exposures significantly increased the risk of different infections. A drug user with a positive urine test for opiates is 80.8 percent more likely to develop sepsis as compared to skin infections (p=0.001). The use of sedatives also significantly increased the odds of developing sepsis by 83.2 percent (p=0.002). Sepsis left untreated will result in a high mortality rate. As illicit drug use increases, sepsis cases will increase. Further research is needed to understand the continued relationship between drug use and the incidence of sepsis. Based on the current evidence, sepsis appears to be slightly affected by drug use and seems to be influenced by sedatives and opiates but only at a marginal level.