Clinical Scorecard: Outcomes of Hepatitis C Therapy in Patients with Infective Endocarditis Managed by a Collaborative Healthcare Team
At a Glance
Category
Detail
Condition
Hepatitis C virus (HCV) infection in patients with infective endocarditis and injection drug use
Key Mechanisms
Interdisciplinary collaboration between specialty pharmacy and endocarditis team to expedite HCV treatment initiation and coordinate outpatient follow-up
Target Population
Patients with infective endocarditis and HCV infection, predominantly with history of injection drug use
Care Setting
Inpatient hospital setting with coordinated outpatient follow-up via specialty pharmacy and infectious diseases consult service
Key Highlights
Among 64 patients with infective endocarditis and HCV, 75% initiated HCV treatment upon discharge; 69% completed treatment.
Sustained virologic response at 12 weeks (SVR12) was achieved in 42% of treated patients and 31% of all patients identified.
Main barriers to treatment completion included loss to follow-up and medication side effects despite expedited interdisciplinary care.
Guideline-Based Recommendations
Diagnosis
Serologic screening for HCV in patients who inject drugs as part of risk factor–directed surveillance (per AASLD and IDSA).
Screen patients admitted with infective endocarditis for HCV and other bloodborne infections.
Management
Offer addiction medicine consultation to patients with active substance use disorder or history of injection drug use.
Use direct-acting antivirals (DAAs) such as sofosbuvir/velpatasvir or glecaprevir/pibrentasvir for HCV treatment.
Coordinate treatment decisions and medication review via multidisciplinary endocarditis team and infectious diseases consult service.
Initiate HCV treatment post-discharge with expedited referral to specialty pharmacy for prior authorization and medication dispensing.
Monitoring & Follow-up
Monitor treatment adherence and side effects during outpatient follow-up.
Assess sustained virologic response at 12 weeks post-treatment completion.
Risks
High risk of loss to follow-up impacting treatment completion and SVR rates.
Potential medication side effects leading to treatment discontinuation.
Barriers related to insurance, dispensing regulations, stigma, and socioeconomic factors.
Patient & Prescribing Data
Patients with infective endocarditis and HCV infection, predominantly young adults with injection drug use history.
75% initiated treatment post-discharge; 69% completed therapy; SVR12 achieved in 42% of treated patients; loss to follow-up and side effects were main reasons for discontinuation.
Clinical Best Practices
Implement multidisciplinary teams including infectious diseases specialists, pharmacists, nurse navigators, and addiction medicine consultants.
Screen all patients with infective endocarditis for HCV infection to identify treatment candidates.
Coordinate expedited outpatient HCV treatment initiation through specialty pharmacy to overcome access barriers.
Provide addiction support services to address comorbid substance use disorders.
Consider strategies to improve retention such as starting therapy inpatient or dispensing full medication course at discharge.
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