Lead Extraction and Mortality Among Patients With Cardiac Implanted Electronic Device Infection

Area of Science:

• Cardiology
• Infectious Diseases
• Health Services Research

Background:

• Complete hardware removal is a Class I recommendation for cardiovascular implantable electronic device (CIED) infections.
• However, current practice patterns and outcomes regarding CIED lead extraction are not well understood.

Purpose of the Study:

• To quantify the incidence of CIED infections and lead extractions among Medicare beneficiaries.
• To analyze the outcomes, specifically mortality, associated with CIED lead extraction in a nationwide clinical practice cohort.

Main Methods:

• A retrospective cohort study analyzed fee-for-service Medicare Part D beneficiaries from 2006-2019.
• Patients with CIED implantation and infection >1 year post-implantation were identified.
• Time-varying multivariable Cox proportional hazards regression models assessed the association between extraction and survival.

Main Results:

• 11,304 patients (1.1%) developed CIED infections; 18.6% underwent extraction within 30 days.
• Infection occurred a mean of 3.7 years post-implantation; 1-year survival was 68.3%.
• Any extraction was associated with lower mortality (AHR, 0.82), with extraction within 6 days showing the greatest benefit (AHR, 0.69).

Conclusions:

• A minority of patients with CIED infection underwent recommended lead extraction.
• Lead extraction, particularly early extraction, is associated with significantly reduced mortality.
• Findings highlight a need to improve adherence to guideline-directed care for CIED infections.