Impact of Cardiac Implantable Electronic Device Infection

Wilkoff, Bruce L.; Boriani, Giuseppe; Mittal, Suneet; Poole, Jeanne E.; Kennergren, Charles; Corey, G. Ralph; Love, J. Christopher; Augostini, Ralph; Færestrand, Svein; Wiggins, S.; Healey, Jeff S.; Holbrook, Reece; Lande, Jeff; Lexcen, Daniel R.; Willey, Sarah; Tarakji, Khaldoun G.

doi:10.1161/circep.119.008280

Cited by 60 publications

(52 citation statements)

References 20 publications

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“…In-hospital mortality is estimated to be ∼5–10%, 35–37 while 1-year all-cause mortality ranges between 16% and 36%, 36–39 although both appear to be reducing over time. 11 , 39 , 40 Hospitalization for CIED infection typically lasts 1–3 weeks, 11 , 29 , 35 , 36 , 40 , 41 with an associated reduction in quality of life. 39 …”

Section: Healthcare Consequencesmentioning

confidence: 99%

Epidemiology of cardiac implantable electronic device infections: incidence and risk factors

et al. 2021

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Epidemiology of CIED Infections: Incidence and Risk Factors Cardiac implantable electronic device (CIED) infection is a potentially devastating complication of CIED procedures, causing significant morbidity and mortality for patients. Of all CIED complications, infection has the greatest impact on mortality, requirement for re-intervention and additional hospital treatment days. Based on large prospective studies, the infection rate at 12-months after a CIED procedure is approximately 1%. The risk of CIED infection may be related to several factors which should be considered with regards to risk minimization. These include technical factors, patient factors, and periprocedural factors. Technical factors include the number of leads and size of generator, the absolute number of interventions which have been performed for the patient, and the operative approach. Patient factors include various non-modifiable underlying comorbidities and potentially modifiable transient conditions. Procedural factors include both peri-operative and post-operative factors. The contemporary PADIT score, derived from a large cohort of CIED patients, is useful for the prediction of infection risk. In this review, we summarize the key information regarding epidemiology, incidence and risk factors for CIED infection.

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Section: Healthcare Consequencesmentioning

confidence: 99%

Epidemiology of cardiac implantable electronic device infections: incidence and risk factors

et al. 2021

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“…Two CEAs have been conducted by clinical study investigators involved in the WRAP-IT. 45 , 46 Both analyses were based on a prior model 47 and because CEA was pre-specified for the WRAP-IT study, both analyses used prospectively collected data for patients’ quality of life (EQ-5D) and healthcare resource use, in addition to clinical endpoints. 43 One study tailored the resource use and cost inputs for the US healthcare system 45 while the second analysis presented data for three European countries (UK, Germany, and Italy).…”

Section: Introductionmentioning

confidence: 99%

“…Death occurred in 10 of the 67 patients in the infection group (12-month Kaplan–Meier estimate: 16%), and 345 of the 6836 patients in the no infection group (12-month Kaplan–Meier estimate: 5%). 46 …”

Section: Introductionmentioning

confidence: 99%

“…The risk-adjusted hazard ratio was 3.41 (95% CI, 1.81–6.41); P < 0.001 at 1 year, and through all follow-up it remained elevated at 2.30 (95% CI, 1.29–4.07); P = 0.004. 46 …”

Section: Introductionmentioning

confidence: 99%

“…Utility scores calculated using the EQ-5D were significantly reduced at time of infection and did not normalize until 6 months later. 46 …”

Section: Introductionmentioning

confidence: 99%

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Infections associated with cardiac electronic implantable devices: economic perspectives and impact of the TYRX™ antibacterial envelope

et al. 2021

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The occurrence of cardiac implantable electronic devices (CIED) infections and related adverse outcomes have an important financial impact on the healthcare system, with hospitalization length of stay (2–3 weeks on average) being the largest cost driver, including the cost of device system extraction and device replacement accounting for more than half of total costs. In the recent literature, the economic profile of the TYRX™ absorbable antibacterial envelope was analysed taking into account both randomized and non-randomized trial data. Economic analysis found that the envelope is associated with cost-effectiveness ratios below USA and European benchmarks in selected patients at increased risk of infection. Therefore, the TYRX™ envelope, by effectively reducing CIED infections, provides value according to the criteria of affordability currently adopted by USA and European healthcare systems.

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Association of the Timing and Extent of Cardiac Implantable Electronic Device Infections With Mortality

et al. 2023

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ImportanceCardiac implantable electronic device (CIED) infection is a potentially devastating complication with an estimated 12-month mortality of 15% to 30%. The association of the extent (localized or systemic) and timing of infection with all-cause mortality has not been established.ObjectiveTo evaluate the association of the extent and timing of CIED infection with all-cause mortality.Design, Setting, and ParticipantsThis prospective observational cohort study was conducted between December 1, 2012, and September 30, 2016, in 28 centers across Canada and the Netherlands. The study included 19 559 patients undergoing CIED procedures, 177 of whom developed an infection. Data were analyzed from April 5, 2021, to January 14, 2023.ExposuresProspectively identified CIED infections.Main Outcomes and MeasuresTime-dependent analysis of the timing (early [≤3 months] or delayed [3-12 months]) and extent (localized or systemic) of infection was performed to determine the risk of all-cause mortality associated with CIED infections.ResultsOf 19 559 patients undergoing CIED procedures, 177 developed a CIED infection. The mean (SD) age was 68.7 (12.7) years, and 132 patients were male (74.6%). The cumulative incidence of infection was 0.6%, 0.7%, and 0.9% within 3, 6, and 12 months, respectively. Infection rates were highest in the first 3 months (0.21% per month), reducing significantly thereafter. Compared with patients who did not develop CIED infection, those with early localized infections were not at higher risk for all-cause mortality (no deaths at 30 days [0 of 74 patients]: adjusted hazard ratio [aHR], 0.64 [95% CI, 0.20-1.98]; P = .43). However, patients with early systemic and delayed localized infections had an approximately 3-fold increase in mortality (8.9% 30-day mortality [4 of 45 patients]: aHR, 2.88 [95% CI, 1.48-5.61]; P = .002; 8.8% 30-day mortality [3 of 34 patients]: aHR, 3.57 [95% CI, 1.33-9.57]; P = .01), increasing to a 9.3-fold risk of death for those with delayed systemic infections (21.7% 30-day mortality [5 of 23 patients]: aHR, 9.30 [95% CI, 3.82-22.65]; P &lt; .001).Conclusions and RelevanceFindings suggest that CIED infections are most common within 3 months after the procedure. Early systemic infections and delayed localized infections are associated with increased mortality, with the highest risk for patients with delayed systemic infections. Early detection and treatment of CIED infections may be important in reducing mortality associated with this complication.

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Impact of Cardiac Implantable Electronic Device Infection

Cited by 60 publications

References 20 publications

Epidemiology of cardiac implantable electronic device infections: incidence and risk factors

Epidemiology of cardiac implantable electronic device infections: incidence and risk factors

Infections associated with cardiac electronic implantable devices: economic perspectives and impact of the TYRX™ antibacterial envelope

Association of the Timing and Extent of Cardiac Implantable Electronic Device Infections With Mortality

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