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

Muhammad Rizwan Sohail1, Charles A Henrikson, Mary Jo Braid-Forbes

  • 1Divisions of Infectious Diseases and Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota.

Pacing and Clinical Electrophysiology : PACE
|September 23, 2014
PubMed

Insights

Cardiovascular implantable electronic device (CIED) infections lead to significantly higher long-term mortality, persisting for years even after treatment. This risk is device-dependent and requires further investigation into its causes.

Area of Science:

  • Cardiology
  • Medical Device Technology
  • Public Health

Background:

  • Device infection is a known complication for patients with cardiovascular implantable electronic devices (CIEDs).
  • Previous studies have not systematically analyzed the long-term mortality impact of CIED infections.
  • This research focuses on a large Medicare beneficiary cohort to assess long-term mortality risks.

Purpose of the Study:

  • To determine the long-term mortality associated with CIED infections.
  • To analyze mortality trends in a large population of Medicare beneficiaries receiving CIEDs.
  • To investigate the duration and device-dependency of increased mortality post-infection.

Main Methods:

  • Retrospective analysis of 200,219 Medicare fee-for-service patients undergoing CIED generator procedures (2007).
  • Assessment of 3-year mortality following CIED implantation, replacement, or revision.
  • Multivariate analysis adjusting for demographics and comorbidities to calculate the relative risk (RR) of death post-infection.

Main Results:

  • CIED infection significantly increased 3-year mortality across all device types: pacemakers (53.8% vs 33%), ICDs (47.7% vs 31.6%), and CRT-Ds (50.8% vs 36.5%).
  • Adjusted analyses revealed persistent increased risk of death for at least 3 years after pacemaker infection.
  • Increased mortality risk persisted for at least 2 years following single- and dual-chamber ICD infections.

Conclusions:

  • CIED recipients who develop infections face increased, device-dependent long-term mortality, even after successful infection treatment.
  • The underlying reasons for this persistent elevated mortality risk remain unknown.
  • Further research is warranted to investigate the etiology of long-term mortality following CIED infection.
Abstract

Keywords:
cardiac resynchronization therapycardiovascular implantable electronic deviceimplantable cardioverter defibrillatorinfectionmortalitypacemaker

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