Cardiac device infections are associated with a significant mortality risk

Bie, Míhàly K. de; Rees, Johannes B. van; Thijssen, Joep; Borleffs, C. Jan Willem; Trines, Serge A.; Cannegieter, Suzanne C.; Schalij, Martin J.; Erven, Lieselot van

doi:10.1016/j.hrthm.2011.10.034

Cited by 73 publications

(43 citation statements)

References 23 publications

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“…In a study of 316 patients with CRT implantation in a single center in France, the prevalence of CDI was 4.3% at 2.6 years (1.7% per year incidence) [18]. In a study of 2476 patients implanted with ICD or CRT-D devices in a single center in The Netherlands, 2.6% underwent device and lead extraction for CDI during a median follow-up of 30 months [11]. Information about healthcare utilization and costs associated with CDI is scarce in Europe.…”

Section: Discussionmentioning

confidence: 99%

“…This limitation may underestimate the CDI rate for replacement procedures, and conversely overestimate the rate for de novo implants. However, this may only have had a small effect, because it is uncommon for CDI to be diagnosed within the same stay as the implant procedure [11,23].…”

Section: Limitationsmentioning

confidence: 99%

“…A USA study based on Medicare inpatient admissions data found that 1-year mortality was between 26.5 and 35.1% depending on device type, an increment compared with patients without CDI of 8.7-15.2% [10]. A European study observed that 1-year mortality for CDI cases was 16.9%, with risk of mortality more than doubled compared with patients who did not experience CDI (hazard ratio: 2.4), with multivariate analysis to control for potential confounding factors [11].…”

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confidence: 99%

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Incidence and costs of cardiac device infections: retrospective analysis using German health claims data

et al. 2018

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Aim: Estimate incidence and costs of cardiac device infections (CDIs) in Germany. Materials & methods:Patients had an implantable cardioverter defibrillator implanted over 2010-2013 and were followed to December 2014 using German health insurance claims data. A case-controlled analysis was performed using propensity score matching methods. Results: Risk of CDI 12 months post-implant was 3.4% overall, either 2.9% for de novo procedures versus 4.4% for replacement procedures. Mean 3-year incremental expenditure per patient for patients with CDI compared with controls was €31,493 for de novo implant patients and €33,777 for replacement patients. Mean incremental expenditure was €59,419 per patient with a major infection. Conclusion: CDIs are highly expensive to manage, reinforcing the need for strategies to reduce their occurrence. [1]. These devices are recommended for selected patients in guidelines from specialty medical societies and health technology assessment agencies [2][3][4]. There is an extensive body of evidence that demonstrates benefits including prolonged survival, improved quality of life and cost-effectiveness.Implantation of cardiac devices carries a risk of adverse events. These are classifiable as access-related (e.g., pneumothorax, hemothorax and hematoma), lead-related (e.g., perforation, displacement, fracture and endocarditis), generator-related (e.g., generator failure, migration and erosion) and pocket infection. Complete removal of all hardware is recommended in medical society guidelines and other scientific documents for patients with established cardiac device-related infection (CDI), and this includes cases in which a localized pocket infection occurs in the absence of signs of systemic infection, due to high relapse rates observed with retained hardware [5][6][7]. On the other hand, cardiac implantable electronic device (CIED) removal is not required for superficial or incisional infection at the pocket site if there is no involvement of the device.A large randomized controlled trial (DANISH study) recently reported an infection rate of 4.9% in a cohort of 556 ICD/CRT-D patients over a median follow-up of 5.6 years [8]. Serious device infections occurred in 2.7% of patients, defined as requiring lead extraction or lifelong antibiotic treatment or causing death. Worryingly, the number of CDI cases has been increasing: national healthcare data for the USA reported the number of hospitalizations due to CDI rose from 5308 in the year 2003 to 9948 in 2011 [9]. The increase is attributed to multiple factors including increased use of CRT devices (which have three leads and a higher risk of infection),

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

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confidence: 99%

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Incidence and costs of cardiac device infections: retrospective analysis using German health claims data

et al. 2018

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“…Other implantable therapeutic foreign bodies in patients with normal immune function, such as pacemakers or implantable cardioverter defibrillators, are more prone to infections (1-6%), which increases the risk of mortality even after successful treatment of the infection [11,12,13]. Pacemaker infection rates from the 1970s to 1980s were even higher (1-19.9%) [14].…”

Section: Resultsmentioning

confidence: 99%

Percutaneous Atrial Septal Closure in Immunocompromised Patients

Kar¹,

Aboulhosn²,

Tandar³

et al. 2017

jshd

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Background: Percutaneous closure devices for cardiac defects have been used with a high degree of efficacy and safety. However, patients with autoimmune disease or immunosuppression are excluded in clinical trials due to their presumed higher risk. Percutaneous closure of patent foramen ovale (PFO) or atrial septal defect (ASD) is safe in patients who are immunosuppressed or have autoimmune disease. Methods: A retrospective observational multicenter study was performed including 24 patients who were immunocompromised or had autoimmune disease from vasculitis, Human Immunodeficiency Virus, hepatitis, cancer, or renal transplant and underwent percutaneous PFO or ASD closure for cryptogenic stroke (9.38%), desaturation (5.21%), migraine (7.29%), or a combination of these diagnoses (3.13%). Post-procedure follow-up included clinical evaluation at 3-6 months or telephone questionnaire up to 8 years later. Results: Of the 24 patients who met inclusion criteria (53 ± 14 years of age, follow-up of 21 ± 28 months), 19 had a PFO (79%), 5 had an ASD (21%), and 21 (88%) underwent closure. There was no evidence of endocarditis, device erosion, exacerbation of migraine, or recurrent stroke. Only one patient (4%) experienced a transient neurologic deficit after closure due to complex migraine with visual aura. Mortality status, which was verified by the social security death index, showed five deaths related to non-cardiac conditions. Conclusion: This observational study of an uncommon condition suggests that percutaneous closure of a PFO or ASD is safe in immunocompromised patients.

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“…53,54 In 1 study, the standardized adjusted incremental and total admission costs for infection were $14 360 to $16 498 and $28 676 to $53 349 for pacemakers and implantable cardioverter-defibrillators respectively. 55 Initial conservative management of confirmed CEID infection is associated with higher relapses and mortality.…”

Section: Outcomes With Cied Infectionsmentioning

confidence: 99%