JACC: Infection rates rise in patients with EP devices

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Researchers have found that patients who receive cardiac electrophysiological devices (CIEDs) are at greater risk of contracting an infection sometime during the lifespan of the device today compared with previous years, according to a 16-year retrospective study published Aug. 30 in the Journal of American College of Cardiology.

Arnold J. Greenspon, MD, division of cardiology at the Thomas Jefferson University Hospital in Philadelphia, and colleagues analyzed the infection burden association with the implantation of CIEDs, and found the incidence of infection was 1.61 percent overall, but the number of infections rose 210 percent from 1993 to 2008.

Using Nationwide Inpatient Sample (NIS) discharge records and the 9th Revision of the International Classification of Diseases (ICD-9), researchers evaluated patient health profiles by coding for renal failure, heart failure, respiratory failure and diabetes. They observed a marked increase in the annual rate of infections in 2004, which coincided with an increase in major comorbidities, according to the study. “This was also associated with a marked increase in mortality and in-hospital charges.

“We believe the growing number of clinical comorbidities in the patient population plays a large role in the increase in infections associated with CIEDs,” Greenspon said in a statement. “The patients are sicker, which may place them at higher risk of infection.”

Patients with a CIED-related infection were identified using an ICD-9 diagnosis code for device-related infection of a CIED removal code, according to the study, and the CIED infection burden was calculated by dividing the number of device-related infections by the corresponding number of primary and revision procedures.

Over the 16-year period, more than 4.2 million primary implantations of pacemakers and implantable cardioverter-defibrillators were identified. “We found that the incidence of CIED implantation increased an average of 4.7 percent annually, and the overall CIED implantation increased by 96 percent from 1993 to 2008,” wrote Greenspon et al. “Approximately 69,000 patients were treated for CIED infection. The incidence of infection increased by 210 percent, from 2,660 cases in 1993 to 8,230 cases in 2008.”

Researchers attributed the infection burden associated with CIED implantation to expanding implantable cardioverter-defibrillator indications and the increasing comorbidities in the CIED population. “Infection is associated with prolonged hospital stays and high financial costs,” the authors concluded. “Further investigation into the risk factors for CIED infection is warranted.”

“The number of Americans receiving pacemakers and defibrillators has dramatically increased. This analysis shows that the infection risk associated with these devices has, unfortunately, increased as well,” said Greenspon.