Key result
Multiple comorbidities are linked to higher risk of 1-year complex CIED infections, occurring at ~0.74%.
Why the study?
The study was conducted to establish the epidemiology of cardiac implantable electronic device infections in Alberta, Canada, using validated administrative data.
Cohort (n=27,830)
Yes
CIED infections occur in 0.74% of implants in Alberta, Canada, and are associated with significantly higher hospitalization and mortality rates, with younger age and multiple comorbidities increasing risk.
Low CIED infection rates may inform consent; this Level 3 evidence leaves open whether comorbidity-targeted prevention reduces events.
OBJECTIVE: To establish the epidemiology of cardiac implantable electronic device (CIED) infections in Alberta, Canada, using validated administrative data. DESIGN: Retrospective, population-based cohort study. SETTING: Alberta Health Services is a province-wide health system that services all of Alberta, Canada. PARTICIPANTS: Adult patients who underwent first-time CIED implantation or generator replacement in Alberta, Canada, between January 1, 2011, and December 31, 2019. METHODS: CIED implant patients were identified from the Paceart database. Patients who developed an infection within 1 year of the index procedure were identified through validated administrative data (International Classification of Diseases, Tenth Revision in Canada). Demographic characteristics of patients were summarized. Logistic regression models were used to analyze device type, comorbidities, and demographics associated with infection rates and mortality. RESULTS: Among 27,830 CIED implants, there were 205 infections (0.74%). Having 2 or more comorbidities was associated with higher infection risk. Generator replacement procedures (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.34-0.84; P = .008), age increase of every 10 years (OR, 0.73; 95% CI, 0.66-0.82; P ≤ .001), and index procedure after 2014 were associated with decreased risk. Comparing the infected to uninfected groups, the hospitalization rates were 2.63 compared to 0.69, and the mortality rates were 10.73% compared to 3.49%, respectively (P < .001). CONCLUSIONS: There is a slightly lower overall rate of CIED infections Alberta, Canada compared to previously described epidemiology. Implants after 2014, and generator replacements showed a decreased burden of infection. Patients with younger age, and 2 or more comorbidities are at greatest risk of CIED infection. The burden of hospitalization and mortality is substantially higher in infected patients.
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King et al. (2023) conducted a cohort in Cardiac implantable electronic device (CIED) infections (n=27,830). CIED implantation was evaluated on Complex CIED infection within 1 year of index procedure. In a population-based cohort of 27,830 CIED implants, the overall 1-year complex infection rate was 0.74%, with higher risk significantly associated with having 2 or more comorbidities.
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