Implantable device infection linked to increased mortality, healthcare costs
MedWire News: Patients with infection associated with cardiovascular implantable electronic device (CIED) therapy are at a significantly higher risk for mortality, a longer hospital stay, and higher healthcare costs than patients with devices uncomplicated by infection, a US study suggests.
Intensive care and pharmacy services accounted for more than half of the incremental cost in infected patients and could be targeted to reduce costs associated with the management of CIED infection, report Mohammed Sohail (Mayo Clinic College of Medicine, Rochester, Minnesota, USA) and co-authors.
The study involved 200,219 Medicare fee-for-service patients who were admitted for CIED generator implantation, replacement, or revision during the year 2007.
The findings, published in JAMA, revealed a total of 5817 admissions with infection.
Infection was associated with significant increases in admission mortality adjusted for demographics and comorbidities (rate ratios=4.8-7.7, depending on CIED type) and long-term mortality (during admission quarter or subsequent four quarters; rate ratios=1.6-2.1), compared with no infection. Patients with pacemakers, implantable cardioverter defibrillators and cardiac resynchronization therapy devices with and without defibrillators were included in the study.
Importantly, write the authors, approximately half of the incremental long-term mortality occurred after discharge.
After adjusting for age, gender, race, and comorbidities, the overall mean admission length of stay was significantly longer in patients with infection (24.3 days) than those without (5.4 days).
The total admission cost with infection, which ranged from US$ 28,676 to US$ 53,349 depending on CIED type, was consistently significantly higher than in those without infection (US$ 12,468-36,851).
Further analysis showed that the largest incremental cost with infection was for intensive care, which accounted for 41% to 50% of the difference between patients with infection and those without.
Overall, adjusted long-term mortality rate and cost ratios with infection were significantly greater for patients with pacemakers than for those with implantable cardioverter/defibrillators or cardiac resynchronization therapy/defibrillator devices, report the authors.
"The etiology of excess mortality in patients with CIED infection after hospital discharge remains unclear and merits further investigation," they conclude.
In a related commentary, Ronan Margrey (Harvard Medical School, Boston, Massachusetts, USA) said of Sohail and team's research: "It is a warning siren to physicians to be sure implantation of cardiac defibrillators is appropriate per professional society guidelines, and to monitor patients at risk for developing infection closely and intervene promptly."
He called for optimized prevention of infection by using skin swabs, documenting fever, avoiding temporary pacing, and irrigating device pockets, amongst other methods.
"In the future, stem cell and/or gene therapy offer the hope of eliminating the need entirely for implantable foreign material," he said.
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By Piriya Mahendra