TY - JOUR
T1 - Comparison of mortality in women versus men with infections involving cardiovascular implantable electronic device
AU - Sohail, M. Rizwan
AU - Henrikson, Charles A.
AU - Braid-Forbes, Mary Jo
AU - Forbes, Kevin F.
AU - Lerner, Daniel J.
N1 - Funding Information:
This study was supported, in part, by a Career Development Award to M.R.S. from the department of medicine, Mayo Foundation for Medical Education and Research . TYRX Inc. provided salary support for M.J.B.-F., K.F.F., and David J. Wright, an acknowledged contributor, to assist with data collection (M.J.B.-F.), analyses (M.J.B.-F. and K.F.F.), and review (D.J.W.). M.R.S and C.A.H. have received funding from TYRX Inc. for previous research. D.J.L. is the Chief Medical Officer for TYRX Inc. and, in that role, has been paid a salary and granted stock options by TYRX Inc. No commercial productions are discussed in this manuscript.
Funding Information:
M.R.S. has received funding from TYRX Inc. for previous research. 17 C.A.H. has received funding from TYRX Inc. for research ( Clinicaltrials.gov NCT01043705 and NCT01043861 ). D.J.L. is the Chief Medical Officer for TYRX Inc., and in that role, has been paid a salary and granted stock options by TYRX.
PY - 2013/11/1
Y1 - 2013/11/1
N2 - Device infection is a complication of implantable cardioverter- defibrillator (ICD) therapy that significantly increases mortality. Risk factors associated with death and ICD infection are poorly understood. The purpose of this study was to identify patient characteristics associated with death after cardiovascular implantable electronic device (CIED) infection. This is a retrospective cohort study of 64,903 Medicare fee-for-service patients who received an ICD in 2007, including 1,855 with device infection. Long-term survival was significantly reduced with CIED infection (71.6% vs 85.0%, p <0.001). Regression analysis accounting for age, race, gender, and 28 co-morbidities identified only 2 patient characteristics associated with decreased long-term survival with CIED infection: female gender and human immunodeficiency virus/acquired immunodeficiency syndrome. In patients with CIED infection, women had substantially reduced long-term survival compared with men (67.3% vs 72.9%, p <0.02). The risk-adjusted hazard ratio for long-term mortality with device infection in women compared with that in men increased significantly from 0.86 (95% confidence interval [CI] 0.82 to 0.91) to 1.25 (95% CI 1.02 to 1.53), corresponding to a risk increase of >45%. Importantly, a substantial portion of this excess mortality occurred after the index admission for infection, when the hazard ratio for death in women compared with that in men increased from 0.86 (95% CI 0.82 to 0.91) to 1.20 (95% CI 0.96 to 1.51) with CIED infection, despite little gender difference in admission length of stay, disposition, and cost. In conclusion, women are significantly more likely than men to die with CIED infection. A substantial part of this excess mortality occurs after discharge. It will be important to identify and address the cause(s) of this gender difference in mortality.
AB - Device infection is a complication of implantable cardioverter- defibrillator (ICD) therapy that significantly increases mortality. Risk factors associated with death and ICD infection are poorly understood. The purpose of this study was to identify patient characteristics associated with death after cardiovascular implantable electronic device (CIED) infection. This is a retrospective cohort study of 64,903 Medicare fee-for-service patients who received an ICD in 2007, including 1,855 with device infection. Long-term survival was significantly reduced with CIED infection (71.6% vs 85.0%, p <0.001). Regression analysis accounting for age, race, gender, and 28 co-morbidities identified only 2 patient characteristics associated with decreased long-term survival with CIED infection: female gender and human immunodeficiency virus/acquired immunodeficiency syndrome. In patients with CIED infection, women had substantially reduced long-term survival compared with men (67.3% vs 72.9%, p <0.02). The risk-adjusted hazard ratio for long-term mortality with device infection in women compared with that in men increased significantly from 0.86 (95% confidence interval [CI] 0.82 to 0.91) to 1.25 (95% CI 1.02 to 1.53), corresponding to a risk increase of >45%. Importantly, a substantial portion of this excess mortality occurred after the index admission for infection, when the hazard ratio for death in women compared with that in men increased from 0.86 (95% CI 0.82 to 0.91) to 1.20 (95% CI 0.96 to 1.51) with CIED infection, despite little gender difference in admission length of stay, disposition, and cost. In conclusion, women are significantly more likely than men to die with CIED infection. A substantial part of this excess mortality occurs after discharge. It will be important to identify and address the cause(s) of this gender difference in mortality.
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U2 - 10.1016/j.amjcard.2013.06.031
DO - 10.1016/j.amjcard.2013.06.031
M3 - Article
C2 - 23972346
AN - SCOPUS:84885947512
SN - 0002-9149
VL - 112
SP - 1403
EP - 1409
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 9
ER -