Chronic kidney disease and transvenous cardiac implantable electronic device infection-is there an impact on healthcare utilization, costs, disease progression, and mortality?

Publisher: Oxford University Press Country of Publication: England NLM ID: 100883649 Publication Model: Print Cited Medium: Internet ISSN: 1532-2092 (Electronic) Linking ISSN: 10995129 NLM ISO Abbreviation: Europace Subsets: MEDLINE

Publication: 2006- : Oxford : Oxford University Press
Original Publication: London ; Philadelphia : Saunders, c1999-

Renal Insufficiency, Chronic*/therapy ; Renal Insufficiency, Chronic*/economics ; Renal Insufficiency, Chronic*/mortality ; Defibrillators, Implantable*/economics ; Defibrillators, Implantable*/adverse effects ; Disease Progression* ; Prosthesis-Related Infections*/economics ; Prosthesis-Related Infections*/mortality ; Pacemaker, Artificial*/economics ; Pacemaker, Artificial*/adverse effects ; Pacemaker, Artificial*/statistics & numerical data; Humans ; Male ; Female ; Retrospective Studies ; Aged ; United States/epidemiology ; Aged, 80 and over ; Health Care Costs/statistics & numerical data ; Medicare/economics ; Patient Acceptance of Health Care/statistics & numerical data ; Length of Stay/statistics & numerical data ; Length of Stay/economics

Aims: Cardiac implantable electronic device (CIED) infections are a burden to hospitals and costly for healthcare systems. Chronic kidney disease (CKD) increases the risk of CIED infections, but its differential impact on healthcare utilization, costs, and outcomes is not known.
Methods and Results: This retrospective analysis used de-identified Medicare Fee-for-Service claims to identify patients implanted with a CIED from July 2016 to December 2020. Outcomes were defined as hospital days and costs within 12 months post-implant, post-infection CKD progression, and mortality. Generalized linear models were used to calculate results by CKD and infection status while controlling for other comorbidities, with differences between cohorts representing the incremental effect associated with CKD. A total of 584 543 patients had a CIED implant, of which 26% had CKD and 1.4% had a device infection. The average total days in hospital for infected patients was 23.5 days with CKD vs. 14.5 days (P < 0.001) without. The average cost of infection was $121 756 with CKD vs. $55 366 without (P < 0.001), leading to an incremental cost associated with CKD of $66 390. Infected patients with CKD were more likely to have septicaemia or severe sepsis than those without CKD (11.0 vs. 4.6%, P < 0.001). After infection, CKD patients were more likely to experience CKD progression (hazard ratio 1.26, P < 0.001) and mortality (hazard ratio 1.89, P < 0.001).
Conclusion: Cardiac implantable electronic device infection in patients with CKD was associated with more healthcare utilization, higher cost, greater disease progression, and greater mortality compared to patients without CKD.
Competing Interests: Conflict of interest: D.J.W. has received research grants and consultancy fees from Medtronic and Boston Scientific and educational fees from Abbot. M.E.T. has received speaker’s fees from Abbot, Biotronik, Boston Scientific, Medtronic, and Microport CRM. J.Z., C.W., R.H., and J.M. are employees of Medtronic, Inc. M.F.E.-C. has received consultant fees from Medtronic and Boston Scientific.
(© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Am J Manag Care. 2017 Jun;23(10 Suppl):S163-S172. (PMID: 28978205)
Europace. 2023 Aug 2;25(9):. (PMID: 37466333)
Pacing Clin Electrophysiol. 2015 Feb;38(2):231-9. (PMID: 25243484)
Arrhythm Electrophysiol Rev. 2016 May;5(1):65-71. (PMID: 27403296)
Circ Arrhythm Electrophysiol. 2020 May;13(5):e008280. (PMID: 32281393)
Heart Rhythm. 2020 Aug;17(8):1393-1397. (PMID: 32247833)
Health Qual Life Outcomes. 2012 Jun 18;10:71. (PMID: 22710013)
Circulation. 2014 Sep 23;130(13):1037-43. (PMID: 25081281)
Europace. 2023 Nov 2;25(11):. (PMID: 37490930)
Eur Heart J. 2022 Dec 14;43(47):4872-4883. (PMID: 36030464)
Arrhythm Electrophysiol Rev. 2022 Apr;11:e19. (PMID: 36304202)
Europace. 2022 Mar 02;24(3):421-429. (PMID: 34431989)
Eur J Cardiothorac Surg. 2020 Jan 1;57(1):e1-e31. (PMID: 31724720)
Pediatr Nephrol. 2017 Feb;32(2):243-248. (PMID: 27115888)
Eur Heart J. 2015 Oct 1;36(37):2473-5. (PMID: 26429906)
Am J Cardiol. 2010 Sep 15;106(6):810-8. (PMID: 21391322)
JAMA Cardiol. 2023 May 1;8(5):484-491. (PMID: 37017943)
BMC Health Serv Res. 2016 Dec 28;16(1):690. (PMID: 28031020)
Heart. 2009 May;95(9):715-20. (PMID: 19036758)
Eur Heart J. 2013 Aug;34(29):2281-329. (PMID: 23801822)
Heart Rhythm. 2016 Jan;13(1):157-64. (PMID: 26341604)
Europace. 2022 Oct 13;24(10):1691-1708. (PMID: 35912932)
J Am Coll Cardiol. 2019 Dec 10;74(23):2845-2854. (PMID: 31806127)
J Pers Med. 2022 Jan 11;12(1):. (PMID: 35055406)
Pacing Clin Electrophysiol. 2011 Aug;34(8):1013-27. (PMID: 21707667)
Europace. 2022 Oct 13;24(10):1627-1635. (PMID: 35718878)
Europace. 2023 Aug 2;25(9):. (PMID: 37703326)
Toxins (Basel). 2020 May 06;12(5):. (PMID: 32384617)
J Cardiovasc Electrophysiol. 2023 Apr;34(4):1015-1023. (PMID: 36807378)
Arch Intern Med. 2011 Nov 14;171(20):1821-8. (PMID: 21911623)
J Clin Epidemiol. 2008 Apr;61(4):344-9. (PMID: 18313558)
Europace. 2018 Dec 1;20(12):1974-1980. (PMID: 29672690)
Eur Heart J. 2024 Apr 7;45(14):1241-1251. (PMID: 38426911)
Lancet. 2020 Feb 29;395(10225):709-733. (PMID: 32061315)
N Engl J Med. 2019 May 16;380(20):1895-1905. (PMID: 30883056)
N Engl J Med. 2023 Jun 22;388(25):2360-2370. (PMID: 37212442)
Pacing Clin Electrophysiol. 2019 Aug;42(8):1105-1110. (PMID: 31232461)
J Comp Eff Res. 2018 May;7(5):483-492. (PMID: 29132224)
JACC Clin Electrophysiol. 2022 Jan;8(1):115-117. (PMID: 34863657)
J Am Coll Cardiol. 2011 Aug 30;58(10):1001-6. (PMID: 21867833)
Heart Rhythm. 2022 Oct;19(10):1689-1695. (PMID: 35643301)
J Interv Card Electrophysiol. 2020 Jan;57(1):27-37. (PMID: 31863250)
PLoS One. 2019 Feb 27;14(2):e0212184. (PMID: 30811447)
J Am Coll Cardiol. 2008 May 27;51(21):e1-62. (PMID: 18498951)
Europace. 2022 Dec 9;24(12):1973-1980. (PMID: 35989511)
PLoS One. 2019 Jan 2;14(1):e0206611. (PMID: 30601808)
J Cardiovasc Electrophysiol. 2011 Oct;22(10):1099-104. (PMID: 21489029)
J Cardiovasc Electrophysiol. 2020 Mar;31(3):712-717. (PMID: 32009284)
Europace. 2015 May;17(5):767-77. (PMID: 25926473)
N Engl J Med. 2022 Oct 6;387(14):1292-1302. (PMID: 36036522)
Sci Rep. 2020 Feb 19;10(1):2938. (PMID: 32076027)
Europace. 2023 Aug 2;25(9):. (PMID: 37572046)

Medtronic

Keywords: CIED infection; Chronic kidney disease; Costs; Disease progression; Healthcare resources; Mortality

Date Created: 20240618 Date Completed: 20240704 Latest Revision: 20240802

20240802

PMC11223657

10.1093/europace/euae169

38890126