Abstract 13135: Increased Incidence of Infection in Cardiac Resynchronization Devices Compared With Pacemakers: Insights from a Longitudinal Medicare Population
Introduction: Infections after cardiac implantable electronic device (CIEDs) procedures are problematic, especially in older patients (pts). Prior studies included few pts with implantable cardioverter defibrillators (ICD) or cardiac resynchronization therapy devices (CRT); it is uncertain if these pts have a greater incidence of infection compared to pacemaker (PM) pts.
Hypothesis: We tested the hypothesis that infection rates were greater after an ICD or CRT vs. PM implant procedure.
Methods: We evaluated the incidence of CIED surgical site infection by device type and initial vs. replacement procedure in a longitudinal cohort of Medicare pts who underwent CIED procedures between 2000- 2006. International Classification of Diseases, Clinical Modification (ICD-9-CM), and Current Procedural Terminology (CPT-4) codes were used to identify device type and to distinguish initial implants from replacement procedures. Device-related infections within 365 days were identified based on ICD-9-CM codes and defined as ≥1 inpatient or ≥2 outpatient claims occurring ≥2 days post-procedure. Multivariable analysis was performed using Cox proportional hazards modeling.
Results: During the study period 77,246 CIEDs were placed. The mean pt age at procedure was 79 years, and 48% were women. The overall infection rate was 1.4%. Age and gender adjusted CIED-related infection rates by device and insertion vs. replacement status are shown (Table). CRTs had significantly higher infection rates [HR 1.45; 95% CI, 1.19-1.77; p<0.001]. ICD infection rates were not significantly different from PMs [p=0.317].
Conclusions: In this large population-based cohort of Medicare pts undergoing CIED procedures, the infection rate within one year was low. The highest infection rate was seen with CRT replacements.
- © 2012 by American Heart Association, Inc.