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Lead Extraction and Mortality Among Patients With CIED Infection
Quick Takes
- The rates of guideline-recommended device extraction among patients aged >65 years with CIED infections were low, such that only 19% underwent extraction within 30 days of diagnosis.
- Any extraction was associated with lower mortality compared with no extraction (adjusted hazard ratio [AHR], 0.82), especially if done within 6 days of diagnosis (AHR, 0.69).
Study Questions:
Among Medicare beneficiaries, what is the incidence of cardiac implantable electronic device (CIED) infections, and what are the outcomes among patients who did and did not undergo lead extraction?
Methods:
This study included fee-for-service Medicare Part D beneficiaries from 2006 to 2019, who had a de novo CIED implantation and a CIED infection >1 year after implantation.
Results:
A total of 1,065,549 patients had CIED implantation. After a mean of 4.6 years after implantation, there were 11,304 patients (1.1%) with CIED infection. The majority, 7,724 (68%), had diabetes. A total of 2,102 patients with CIED infection (19%) underwent extraction within 30 days of diagnosis. Infection occurred a mean of 3.7 years after implantation, and 1-year survival was 68%. There was evidence of highly selective treatment, as most patients did not have extraction within 30 days of diagnosed infection (81%), while 13% had extraction within 6 days of diagnosis and 5% had extraction between days 7 and 30. Any extraction was associated with lower mortality compared with no extraction (adjusted hazard ratio [AHR], 0.82; p < 0.001). Extraction within 6 days was associated with even lower risk of mortality (AHR, 0.69; p < 0.001).
Conclusions:
In this study, a minority of patients with CIED infection underwent extraction. Extraction was associated with a lower risk of death compared with no extraction. The findings suggest a need to improve adherence to guideline-directed care among patients with CIED infection.
Perspective:
Antibiotics alone are not effective for treatment of CIED infection and complete hardware removal is a Class I guideline recommendation for patients with CIED infection. The current study shows that CIED infection patients have high morbidity and mortality, and shockingly, most of those patients did not have extraction within 30 days of the diagnosed infection. Patients who underwent an extraction had significantly lower mortality, and those who underwent the extraction within 1 week of diagnosis did better still. The real-world practice for patients with CIED infections is abysmally inadequate. There is a need to improve care of patients with CIED infection.
Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, SCD/Ventricular Arrhythmias, Cardiac Surgery and Arrhythmias
Keywords: Defibrillators, Implantable, Infections
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