Heart failure - An unexplored risk factor for infective endocarditis after pacemaker implantation

Area of Science:

• Cardiology
• Infectious Diseases
• Biostatistics

Background:

• Permanent pacemakers (PPM) are widely used, but pacemaker endocarditis (IE) increases mortality.
• Heart failure (HF) is a common comorbidity in PPM patients, yet its independent risk for IE remains understudied.
• Evaluating comorbidities like HF is crucial for understanding and mitigating IE risk in the PPM population.

Purpose of the Study:

• To investigate whether heart failure (HF) is an independent risk factor for infective endocarditis (IE) in patients with permanent pacemakers (PPM).
• To compare IE rates between patients with HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF).

Main Methods:

• Utilized the US National Inpatient Sample database for a large cohort of PPM patients.
• Excluded patients with specific conditions (e.g., ICD, acute HF, prior IE, IV drug use, prosthetic valves, CVC infection).
• Employed propensity score matching and logistic regression to assess HF as an independent predictor of IE.

Main Results:

• Out of 333,571 PPM patients, 37% had HF. HF patients were older, more likely female, and had higher comorbidity prevalence.
• Pre-matching analysis showed HF increased IE likelihood by 1.30 times (OR: 1.30).
• Post-propensity matching, HF remained an independent risk factor for IE (OR: 1.62), with similar IE rates in HFrEF and HFpEF subgroups.

Conclusions:

• Heart failure (HF) is independently associated with an increased risk of infective endocarditis (IE) in the permanent pacemaker (PPM) population.
• The low-flow, high-inflammatory state associated with HF may contribute to the elevated IE risk.
• Further research is needed to confirm these findings and explore potential antimicrobial prophylaxis strategies for high-risk HF patients with PPM.