Cardiac Implantable Electronic Device Infection: Nationwide Trends in Extraction Utilization and In-Hospital Outcomes

Contemporary, real-world adherence to guideline-directed transvenous cardiac implantable electronic device (CIED) extraction for patients with CIED infections in the US remains incompletely characterized. As such, we sought to evaluate national trends in CIED extraction and identify factors associated with extraction and in-hospital mortality.

A retrospective analysis of adult hospitalizations with CIED infection using the National Inpatient Sample from 2016 to 2022 was performed. National trends in extraction, factors associated with extraction, and predictors of in-hospital mortality were evaluated. Multivariable logistic regression and propensity score matching were used to estimate adjusted associations with mortality.

Among 47,835 adults hospitalized with a CIED infection, 10,905 (22.8%) underwent extraction. National extraction rates increased modestly from 16.2% in 2016 to 23.8% in 2022 (p < 0.001) but remained low overall. Unadjusted in-hospital mortality was lower among patients who underwent extraction compared with those who did not (2.8% vs. 4.4%; p = 0.001). After adjustment, extraction was independently associated with lower mortality (OR 0.59 [95% CI, 0.44-0.80]). Higher mortality was associated with increasing age, greater comorbidity burden, and markers of acute illness severity, including acute kidney injury, cardiogenic shock, and respiratory failure. Among patients who underwent extraction, markers of acute organ failure remained associated with adjusted in-hospital mortality.

In this contemporary, multi-payor, national cohort of patients with CIED infections, CIED extraction was independently associated with lower in-hospital mortality, but was significantly underutilized despite guideline recommendations. Mortality among those who underwent extraction was driven primarily by acute illness severity, emphasizing the need for early recognition and timely intervention. System-level strategies to improve access to extraction may help align real-world practice with guidelines.