The Heart of the Matter: Supporting Patients with Endocarditis and Addiction

Understanding Endocarditis and Its Challenges

On a cardiac unit, I see all types of heart and vascular diseases. Many of them appear in the same "type" of patient. Peripheral vascular disease usually affects diabetics or smokers. Coronary artery disease often shows up in people who are a bit heavier than is healthy. And then there's endocarditis. This condition is often found in young people with a history of IV drug use.

Endocarditis, an inflammation of heart tissue, is frequently caused by infection. Those engaging in IV drug abuse risk introducing bacteria directly into their bloodstream every time they use. Usually, your immune system can fight off these invaders, but not always. Sometimes, exposure to bacteria is just too much for the body to handle, and the heart ends up infected.

The Reality of Treatment

Most of the patients we get with endocarditis are preparing for a replacement of the infected heart valve. While endocarditis can be treated with antibiotics, we see surgical cases more often. The sad reality is that drug addiction is a hard battle to fight. Whether you believe it is a "disease" or not doesn't change the pattern we usually see. More often than not, these patients get a new heart valve, go home, and end up right back where they started by continuing IV drug use.

Eventually, hospitals start denying repeat valve replacements. If the patient hasn't shown a commitment to caring for a donated valve after a risky surgery, why keep throwing new ones their way? It's crucial to recognize the difference between a genuine commitment to change and just saying you're committed without making a proper effort. Fighting drug addiction is a steep uphill battle that often involves relapses, especially if the patient lacks adequate support outside the hospital.

A New Approach: The Pilot Program

Five years ago, my manager, Lauren, decided to pilot a program for providing support outside the hospital for patients with new valves. Sheila was our first participant.

Sheila was a small, young girl in her mid-20s with a well-documented history of IV drug abuse. Like many others, she received a heart valve replacement and then continued her drug use until her new heart valve became diseased as well. When she came back, most of the nurses knew her and had started to get to know her story. Sheila was sweet and polite, always accompanied by her mom. But there was always a bit of a dark cloud hanging over her. We could tell she was struggling, and it broke our hearts to see her return with an infection of her recent heart valve.

At first, the doctors told her she was out of luck. Many surgeons, doctors, and nurses had put their time, effort, and licenses on the line when they operated on her. It was understandably upsetting to see how quickly her new chance at life was neglected. But Lauren spoke up about how we kept releasing these patients with minimal out-of-hospital support in fighting their addiction.

We would give them a new valve, tell them, "Good luck, don’t do drugs," and send them off. Unfortunately, that's rarely enough to help someone fight a drug addiction. So, the hospital decided to pilot a program where Sheila would get a second valve, in exchange for her signed commitment to follow an outpatient treatment plan. This plan included escorts to rehab meetings, frequent check-ins, and education. The hope was that providing extra support after being sent home would increase their chances of successfully conquering their addiction. Sheila agreed, signed the commitment, and got her second chance.

The Initial Success

At first, it seemed to be working. Sheila complied with the treatment plan, showed up to rehab meetings, and followed through on the steps we had asked her to take. It was encouraging and exciting to see her stick with it.

But, as we know, IV drug use is a beast that is hard to fully get rid of. One day, Sheila just stopped attending meetings and check-ins. We tried to contact her and keep her on track. We did whatever we could to support her fight, but it just wasn't enough. She relapsed, enabled by her own mother, and ended up hospitalized once again. Sadly, the doctors had had enough and gave her a few months to live. I don't actually know her current status, but I'm sure by now she's gone unless she found a different hospital willing to overlook the relapses and try again.

Reflecting on the Program's Potential

The reason this story sticks with me is that I honestly believe there was potential in that program we were piloting. It may not work for everyone, like it didn't work for Sheila, but I think it could work for some—particularly patients who have children depending on them to get better.

I've sat and listened to patients cry and vent about how horrible they feel letting down their kids. They express how they need to overcome their addiction to care for their children and see them grow up. Sometimes, I wish we could try the program again. The concept makes sense, and it's better than sending patients off with minimal support. But, as far as I know, we have not attempted it again since Sheila.

With the drug abuse epidemic going on right now, maybe it's time to try again...

The Moral of the Story

Drug addiction is no easy struggle to overcome. I personally believe we are failing our patients when we discharge them with new heart valves and minimal outpatient support. It's like treating someone with high blood sugar in the setting of new diabetes and then discharging them without prescriptions for insulin or glucose monitoring or education on diet. That's just unthinkable!

We always discharge our diabetic patients with copious research, guides, and resources. They don't always comply, but at least they are given what they need to try. Why can't we do the same for IV drug addiction and valve replacement patients?

In conclusion, we must advocate for better support systems for our patients. They deserve more than just a quick fix. They need a fighting chance!

• Bella, RN