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

Area of Science:

• Cardiology
• Infectious Diseases
• Health Services Research

Background:

• Guideline-directed transvenous cardiac implantable electronic device (CIED) extraction for CIED infections is recommended but its real-world adherence in the US is not well-characterized.
• Understanding national trends and factors influencing CIED extraction is crucial for improving patient care.

Purpose of the Study:

• To evaluate national trends in CIED extraction for patients with CIED infections in the US.
• To identify factors associated with CIED extraction and in-hospital mortality.
• To assess the association between CIED extraction and in-hospital mortality.

Main Methods:

• Retrospective analysis of adult hospitalizations with CIED infection from 2016 to 2022 using the National Inpatient Sample.
• Evaluation of national trends, factors associated with extraction, and predictors of in-hospital mortality.
• Application of multivariable logistic regression and propensity score matching to estimate adjusted associations with mortality.

Main Results:

• Among 47,835 hospitalizations for CIED infection, only 22.8% underwent extraction, with rates modestly increasing from 16.2% to 23.8% nationally.
• CIED extraction was independently associated with significantly lower in-hospital mortality (OR 0.59; 95% CI, 0.44-0.80).
• Higher mortality was linked to older age, greater comorbidity burden, and acute illness severity (acute kidney injury, cardiogenic shock, respiratory failure).

Conclusions:

• Despite guideline recommendations, CIED extraction for CIED infections is significantly underutilized in the US.
• CIED extraction is independently associated with reduced in-hospital mortality.
• Improving access to timely CIED extraction and managing acute illness severity are critical for enhancing patient survival.