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Chronic kidney disease and transvenous cardiac implantable electronic device infection-is there an impact on healthcare utilization, costs, disease progression, and mortality?
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- Author(s): Wright DJ;Wright DJ; Trucco ME; Trucco ME; Zhou J; Zhou J; Wolff C; Wolff C; Holbrook R; Holbrook R; Margetta J; Margetta J; El-Chami MF; El-Chami MF
- Source:
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology [Europace] 2024 Jul 02; Vol. 26 (7).- Publication Type:
Journal Article- Language:
English - Source:
- Additional Information
- Source: 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 Information: Publication: 2006- : Oxford : Oxford University Press
Original Publication: London ; Philadelphia : Saunders, c1999- - Subject Terms: 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
- Abstract: 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.
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Europace. 2023 Aug 2;25(9):. (PMID: 37572046) - Grant Information: Medtronic
- Contributed Indexing: Keywords: CIED infection; Chronic kidney disease; Costs; Disease progression; Healthcare resources; Mortality
- Publication Date: Date Created: 20240618 Date Completed: 20240704 Latest Revision: 20240802
- Publication Date: 20240802
- Accession Number: PMC11223657
- Accession Number: 10.1093/europace/euae169
- Accession Number: 38890126
- Source:
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