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

Muhammad Rizwan Sohail, Charles 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

    Fingerprint

    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
    • Medicine(all)

    Cite this

    Increased long-term mortality in patients with cardiovascular implantable electronic device infections. / Rizwan Sohail, Muhammad; Henrikson, Charles; 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 ; 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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    AU - Henrikson, Charles

    AU - Jo Braid-Forbes, Mary

    AU - Forbes, Kevin F.

    AU - Lerner, Daniel J.

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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.

    AB - 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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