Key result
Overall CIED infection rates average 1.61%, with marked increases linked to rising major comorbidities.
Why the study?
Recent data suggested that the rate of infection following cardiac implantable electrophysiological device implantation might be increasing.
Has the infection burden associated with CIED implantation in the United States changed between 1993 and 2008?
Observational
Yes
Has the infection burden associated with CIED implantation in the United States changed between 1993 and 2008?
The incidence of CIED infections in the US increased significantly after 2004, correlating with a higher burden of patient comorbidities, and is associated with increased mortality and healthcare costs.
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The number of Americans receiving pacemakers and defibrillators has dramatically increased. This analysis shows that the infection risk associated with these devices has, unfortunately, increased as well.”
“I don't want people to come away with the misconception that pacemakers and defibrillators are dangerous. In fact, in the case of implantable defibrillators, there have been some studies that have shown they're underutilized. The challenge is that we are putting these devices in sicker, older patients that have more comorbidities, so we need to develop strategies to minimize infection.”
“Since people are living longer, the population is older and that means more heart disease—qualifying more people for these devices. So overall, we're implanting more devices than we ever did before, and they're going into patients that are sicker and frailer to begin with. And since we're looking at an older population with more comorbidities, the patients are more prone to complications. If they do develop infection, they may be less likely to overcome it.”
Rising CIED infections with comorbidities may warrant closer monitoring; leaves open whether risk-factor modification reduces incidence.
OBJECTIVES: We analyzed the infection burden associated with the implantation of cardiac implantable electrophysiological devices (CIEDs) in the United States for the years 1993 to 2008. BACKGROUND: Recent data suggest that the rate of infection following CIED implantation may be increasing. METHODS: The Nationwide Inpatient Sample (NIS) discharge records were queried between 1993 and 2008 using the 9th Revision of the International Classification of Diseases (ICD-9-CM). CIED infection was defined as either: 1) ICD-9 code for device-related infection (996.61) and any CIED procedure or removal code; or 2) CIED procedure code along with systemic infection. Patient health profile was evaluated by coding for renal failure, heart failure, respiratory failure, and diabetes mellitus. The infection burden and patient health profile were calculated for each year, and linear regression was used to test for changes over time. RESULTS: During the study period (1993 to 2008), the incidence of CIED infection was 1.61%. The annual rate of infections remained constant until 2004, when a marked increase was observed, which coincided with an increase in the incidence of major comorbidities. This was associated with a marked increase in mortality and in-hospital financial charges. CONCLUSIONS: The infection burden associated with CIED implantation is increasing over time and is associated with prolonged hospital stays and high financial costs.
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Greenspon et al. (2011) conducted an observational in Cardiac implantable electrophysiological device (CIED) implantation. Cardiac implantable electrophysiological device (CIED) implantation was evaluated on Incidence of CIED infection. The overall incidence of CIED infection in the United States between 1993 and 2008 was 1.61%, with a marked increase starting in 2004 that coincided with rising major comorbidities.
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