Infected Heart Devices Often Unremoved Against Guidelines
Against the recommendations of professional cardiology societies, most infected cardiac implantable electronic devices (CIED) go unremoved, increasing the risk of relapse and death, according to the results of a Medicare database study.
Researchers analyzed data from 1.1 million Medicare patients who received a new CIED from 2006 to 2019 that got infected more than 12 months after implantation. Patients had to have received antibiotic therapy within 30 days after the device infection was diagnosed to be included in the analysis.
Study outcomes included diagnosis of device infection, device extraction, time to
extraction, and all-cause mortality. The team used time-varying, multivariable Cox models to evaluate the association between extraction and mortality.
Researchers found that 11,619, or roughly 1%, of these patients contracted a CIED infection after a median length of follow-up of 4.6 years. Most infected patients (n = 9510, or 82%) did not have their CIED removed within 30 days of diagnosis, and their 1-year mortality was 32%. However, 1515, or 13% of infected patients, had their device removed within 6 days of diagnosis, and their 1-year mortality was 19%.
“Extraction was associated with 27% lower hazard of mortality [and] earlier extraction was associated with 41% lower hazard of mortality, significantly lower compared with later extraction,” researchers concluded. “Quality improvement initiatives and care redesign programs are needed in order to improve the guideline-based care that CIED patients receive within health systems.”
Pokorney SD, Zepel L, Greiner MA, et al. Low rates of guideline directed care associated with higher mortality among patients with cardiac implanted electronic device infection. Paper presented at: 2022 American College of Cardiology Scientific Sessions; April 3, 2022; Washington, DC. Accessed April 22, 2022.