Increased long-term mortality in patients with cardiovascular implantable electronic device infections

Muhammad Rizwan Sohail, Charles A. Henrikson, Mary Jo Braid-Forbes, Kevin F. Forbes, Daniel J. Lerner

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background Device infection is associated with increased mortality in patients receiving cardiovascular implantable electronic device (CIED) therapy. However, long-term mortality associated with CIED infections has not been systematically analyzed in larger studies. This study sought to determine the long-term mortality associated with CIED infection in a large cohort of Medicare beneficiaries. Methods We used a retrospective study design to analyze 3-year mortality in 200,219 Medicare fee-for-service patients admitted for CIED generator implantation, replacement, or revision between January 1, 2007 and December 31, 2007. Multivariate analysis adjusting for age, sex, race, and 28 comorbidities was performed to determine the relative risk (RR) of death in the 12 quarters following CIED infection. Results Patients with CIED infection, compared to device recipients without infection, had increased mortality that persisted for at least 3 years after the admission quarter for all device types: pacemakers (PMs: 53.8% vs 33%; P < 0.001), implantable cardioverter defibrillator (ICD: 47.7% vs 31.6%; P < 0.001), and cardiac resynchronization therapy-defibrillator (CRT-D: 50.8% vs 36.5%; P < 0.001). After adjusting for patient demographics and comorbidities, significantly increased RR of death following CIED infection persisted for at least 3 years following PM infection, and for at least 2 years with single- and dual-chamber ICD infection. Conclusions CIED recipients who develop device infection have increased, device-dependent, long-term mortality even after successful treatment of infection. The etiology of this persistent increased risk of death associated with CIED infection is unknown and merits further investigation.

Original languageEnglish (US)
Pages (from-to)231-239
Number of pages9
JournalPACE - Pacing and Clinical Electrophysiology
Volume38
Issue number2
DOIs
StatePublished - Feb 1 2015

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Equipment and Supplies
Mortality
Infection
Medicare
Comorbidity
Fee-for-Service Plans
Cardiac Resynchronization Therapy
Defibrillators
Implantable Defibrillators
Multivariate Analysis
Retrospective Studies
Demography
Therapeutics

Keywords

  • cardiac resynchronization therapy
  • cardiovascular implantable electronic device
  • implantable cardioverter defibrillator
  • infection
  • mortality
  • pacemaker

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Increased long-term mortality in patients with cardiovascular implantable electronic device infections. / Rizwan Sohail, Muhammad; Henrikson, Charles A.; Jo Braid-Forbes, Mary; Forbes, Kevin F.; Lerner, Daniel J.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 38, No. 2, 01.02.2015, p. 231-239.

Research output: Contribution to journalArticle

Rizwan Sohail, Muhammad ; Henrikson, Charles A. ; Jo Braid-Forbes, Mary ; Forbes, Kevin F. ; Lerner, Daniel J. / Increased long-term mortality in patients with cardiovascular implantable electronic device infections. In: PACE - Pacing and Clinical Electrophysiology. 2015 ; Vol. 38, No. 2. pp. 231-239.
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abstract = "Background Device infection is associated with increased mortality in patients receiving cardiovascular implantable electronic device (CIED) therapy. However, long-term mortality associated with CIED infections has not been systematically analyzed in larger studies. This study sought to determine the long-term mortality associated with CIED infection in a large cohort of Medicare beneficiaries. Methods We used a retrospective study design to analyze 3-year mortality in 200,219 Medicare fee-for-service patients admitted for CIED generator implantation, replacement, or revision between January 1, 2007 and December 31, 2007. Multivariate analysis adjusting for age, sex, race, and 28 comorbidities was performed to determine the relative risk (RR) of death in the 12 quarters following CIED infection. Results Patients with CIED infection, compared to device recipients without infection, had increased mortality that persisted for at least 3 years after the admission quarter for all device types: pacemakers (PMs: 53.8{\%} vs 33{\%}; P < 0.001), implantable cardioverter defibrillator (ICD: 47.7{\%} vs 31.6{\%}; P < 0.001), and cardiac resynchronization therapy-defibrillator (CRT-D: 50.8{\%} vs 36.5{\%}; P < 0.001). After adjusting for patient demographics and comorbidities, significantly increased RR of death following CIED infection persisted for at least 3 years following PM infection, and for at least 2 years with single- and dual-chamber ICD infection. Conclusions CIED recipients who develop device infection have increased, device-dependent, long-term mortality even after successful treatment of infection. The etiology of this persistent increased risk of death associated with CIED infection is unknown and merits further investigation.",
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N2 - Background Device infection is associated with increased mortality in patients receiving cardiovascular implantable electronic device (CIED) therapy. However, long-term mortality associated with CIED infections has not been systematically analyzed in larger studies. This study sought to determine the long-term mortality associated with CIED infection in a large cohort of Medicare beneficiaries. Methods We used a retrospective study design to analyze 3-year mortality in 200,219 Medicare fee-for-service patients admitted for CIED generator implantation, replacement, or revision between January 1, 2007 and December 31, 2007. Multivariate analysis adjusting for age, sex, race, and 28 comorbidities was performed to determine the relative risk (RR) of death in the 12 quarters following CIED infection. Results Patients with CIED infection, compared to device recipients without infection, had increased mortality that persisted for at least 3 years after the admission quarter for all device types: pacemakers (PMs: 53.8% vs 33%; P < 0.001), implantable cardioverter defibrillator (ICD: 47.7% vs 31.6%; P < 0.001), and cardiac resynchronization therapy-defibrillator (CRT-D: 50.8% vs 36.5%; P < 0.001). After adjusting for patient demographics and comorbidities, significantly increased RR of death following CIED infection persisted for at least 3 years following PM infection, and for at least 2 years with single- and dual-chamber ICD infection. Conclusions CIED recipients who develop device infection have increased, device-dependent, long-term mortality even after successful treatment of infection. The etiology of this persistent increased risk of death associated with CIED infection is unknown and merits further investigation.

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