Clin Infect Dis. 2020 Aug 5:ciaa1126. doi: 10.1093/cid/ciaa1126. Online ahead of print.
BACKGROUND: Among those with injection drug use-associated infective endocarditis (IDU-IE), against medical advice (AMA) discharge is common and linked to adverse outcomes. Understanding trends, risk factors and timing is needed to reduce IDU-IE AMA discharges.
METHODS: We identified individuals ages 18-64 with International Classification of Diseases, 9thRevision diagnosis codes for infective endocarditis (IE) in the National Inpatient Sample, a representative sample of United States hospitalizations from January 2010 to September 2015. We plotted unadjusted quarter-year trends for AMA discharges and used multivariable logistic regression to identify factors associated with AMA discharge among IE hospitalizations, comparing IDU-IE to non-IDU-IE.
RESULTS: We identified 7,259 IDU-IE and 23,633 non-IDU-IE hospitalizations. Of these hospitalizations, 14.2% of IDU-IE and 1.9% of non-IDU-IE resulted in AMA discharges. More than 30% of AMA discharges for both groups occurred before hospital day 3. In adjusted models, IDU status [Adjusted Odds Ratio (AOR) 3.92 (95% CI: 3.43-4.48)] was associated with increased odds of AMA discharge. Among IDU-IE, women [AOR 1.21 (95% CI: 1.04-1.41)] and Hispanics [AOR 1.32 (95% CI: 1.03-1.69)] had increased odds of AMA discharge, which differed from non-IDU-IE. Over nearly 6-years, odds of AMA discharge increased 12% per year for IDU-IE [AOR 1.12 (95% CI: 1.07-1.18)] and 6% per year for non-IDU-IE [AOR 1.06 (95% CI: 1.00-1.13)].
CONCLUSION: AMA discharges have risen among individuals with IDU-IE and non-IDE-IE. Among those who inject drugs, AMA discharges were more common and increases sharper. Efforts that address the rising fraction, disparities, and timing of IDU-IE AMA discharges are needed.