Key result
Hospitalization for cardiac device infection during the COVID-19 pandemic was not associated with altered adjusted odds of major adverse events (AOR 1.05) compared to the pre-pandemic period.
Why the study?
The COVID-19 pandemic caused resource diversion and reduced cardiovascular disease presentations, but its association with outcomes and resource utilization for cardiac device infection hospitalizations remained unclear.
Does admission during the COVID-19 pandemic affect major adverse events and resource utilization in adult patients hospitalized for cardiac device infection?
Cohort (n=190,160)
Yes
Does admission during the COVID-19 pandemic affect major adverse events and resource utilization in adult patients hospitalized for cardiac device infection?
Odds Ratio: 1.05 (95% CI 0.98–1.12)
Absolute Event Rate: 31% vs 28.9%
The COVID-19 pandemic did not significantly impact clinical outcomes for patients admitted with cardiac device infections, though it was associated with shorter hospital stays and higher costs.
Pandemic CDI admissions linked to shorter stays but higher costs without worse outcomes; leaves open questions on care efficiency and resource allocation in future disruptions.
BACKGROUND: Cardiac device infection (CDI) can occur in up to 2.2% of patients after device placement, with mortality rates exceeding 15%. Although device removal is standard management, the COVID-19 pandemic has been associated with resource diversion and decreased patient presentation for cardiovascular disease. We ascertained the association of the COVID-19 pandemic with outcomes and resource utilization after admission for CDI. METHODS: The 2016-2020 National Inpatient Sample was used to retrospectively study all adult admissions for CDI. Patients admitted between March and December, 2020 were classified as the pandemic cohort, with the rest pre-pandemic. The primary outcome was major adverse events (MAE), with secondary outcomes of overall length of stay (LOS), post-device removal LOS, time to device replacement, and hospitalization costs. MAE was a combination of in-hospital mortality and select complications. Multivariable regression models were developed to determine the relationship between the pandemic and the aforementioned outcomes. RESULTS: Of an estimated 190,160 patients, 14.3% comprised the pandemic cohort; 2.4% of these patients were COVID-19 positive. The pandemic cohort was older, less commonly female, and had higher rates of congestive heart failure. After adjustment, the pandemic was not associated with altered odds of MAE, device removal, or subsequent device replacement. The pandemic was, however, associated with decreased adjusted overall LOS (β -0.38 days) and days to device replacement (β -0.83 days). The pandemic was likewise associated with $2,000 increased adjusted hospitalization costs. CONCLUSION: The pandemic did not have a significant impact on clinical outcomes in patients admitted for CDI, despite higher hospitalization costs and decreased length of stay.
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Ascandar et al. (2023) conducted a cohort in Cardiac device infection (n=190,160). COVID-19 pandemic period vs. Pre-pandemic period was evaluated on In-hospital major adverse events (MAE) (AOR 1.05, 95% CI 0.98-1.12). Hospitalization for cardiac device infection during the COVID-19 pandemic was not associated with altered adjusted odds of major adverse events (AOR 1.05) compared to the pre-pandemic period.
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