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Shawon MSR, Sotade OT, Li J, Hill MD, Strachan L, Challis G, King K, Ooi SY, Jorm L. Factors associated with cardiac implantable electronic device-related infections, New South Wales, 2016-21: a retrospective cohort study. Med J Aust 2024; 220:510-516. [PMID: 38711337 DOI: 10.5694/mja2.52302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 01/22/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVES To quantify the rate of cardiac implantable electronic device (CIED)-related infections and to identify risk factors for such infections. DESIGN Retrospective cohort study; analysis of linked hospital admissions and mortality data. SETTING, PARTICIPANTS All adults who underwent CIED procedures in New South Wales between 1 January 2016 and 30 June 2021 (public hospitals) or 30 June 2020 (private hospitals). MAIN OUTCOME MEASURES Proportions of patients hospitalised with CIED-related infections (identified by hospital record diagnosis codes); risk of CIED-related infection by patient, device, and procedural factors. RESULTS Of 37 675 CIED procedures (23 194 men, 63.5%), 500 were followed by CIED-related infections (median follow-up, 24.9 months; interquartile range, 11.2-40.8 months), including 397 people (1.1%) within twelve months of their procedures, and 186 of 10 540 people (2.5%) at high risk of such infections (replacement or upgrade procedures; new cardiac resynchronisation therapy with defibrillator, CRT-D). The overall infection rate was 0.50 (95% confidence interval [CI], 0.45-0.54) per 1000 person-months; it was highest during the first month after the procedure (5.60 [95% CI, 4.89-6.42] per 1000 person-months). The risk of CIED-related infection was greater for people under 65 years of age than for those aged 65-74 years (adjusted hazard ratio [aHR], 1.71; 95% CI, 1.32-2.23), for people with CRT-D devices than for those with permanent pacemakers (aHR, 1.46; 95% CI, 1.02-2.08), for people who had previously undergone CIED procedures (two or more v none: aHR, 1.51; 95% CI, 1.02-2.25) or had CIED-related infections (aHR, 11.4; 95% CI, 8.34-15.7), or had undergone concomitant cardiac surgery (aHR, 1.62; 95% CI, 1.10-2.39), and for people with atrial fibrillation (aHR, 1.33; 95% CI, 1.11-1.60), chronic kidney disease (aHR, 1.54; 95% CI, 1.27-1.87), chronic obstructive pulmonary disease (aHR, 1.37; 95% CI, 1.10-1.69), or cardiomyopathy (aHR 1.60; 95% CI, 1.25-2.05). CONCLUSIONS Knowledge of risk factors for CIED-related infections can help clinicians discuss them with their patients, identify people at particular risk, and inform decisions about device type, upgrades and replacements, and prophylactic interventions.
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Affiliation(s)
| | | | - Joan Li
- Prince of Wales Hospital, Sydney, NSW
| | | | | | | | - Kate King
- Medtronic Australasia Pty Ltd, Sydney, NSW
| | | | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW
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Ngo L, Denman R, Hay K, Kaambwa B, Ganesan A, Ranasinghe I. Excess Bed Days and Hospitalization Costs Associated With 30-Day Complications Following Catheter Ablation of Atrial Fibrillation. J Am Heart Assoc 2023; 12:e030236. [PMID: 38038189 PMCID: PMC10727335 DOI: 10.1161/jaha.123.030236] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND The incidence and type of complications following catheter ablation of atrial fibrillation have been extensively examined, but the impact associated with these complications on the length of stay and hospitalization costs is unknown. METHODS AND RESULTS This cohort study included 20 117 adult patients (mean age 62.6±11.4 years, 30.3% women, median length of stay 1 day [interquartile range 1-2 days]) undergoing atrial fibrillation ablation in financial years 2011 to 2017 in Australia with available cost data from the National Hospital Cost Data Collection, which determines government reimbursement of health services provided. The primary outcome was the costs associated with complications occurring up to 30 days postdischarge adjusted for inflation to 2021 Australian dollars. We used generalized linear models to estimate the increase in length of stay and cost associated with complications, adjusting for patient characteristics. Within 30 days of hospital discharge, 1151 (5.72%) patients experienced a complication with bleeding (3.35%) and pericardial effusion (0.75%) being the most common. On average, the occurrence of a complication was associated with an adjusted 3.3 (95% CI, 3.1-3.6) excess bed days of hospital care (totaling 3851 days), and a $7812 (95% CI, $6754-$8870) increase in hospitalization cost (totaling $9.0 million). Most of the total excess cost was attributable to bleeding ($3.8 million, 41.9% of total excess cost) and pericardial effusion ($1.6 million, 18.2%). CONCLUSIONS Complications following atrial fibrillation ablation were associated with significant increase in length of stay and hospitalization costs, most of which were attributable to bleeding and pericardial effusion. Strategies to improve procedural safety and reduce health care costs should focus on these complications.
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Affiliation(s)
- Linh Ngo
- Greater Brisbane Clinical School, Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
- Department of Cardiology, The Prince Charles HospitalBrisbaneQueenslandAustralia
| | - Russell Denman
- Department of Cardiology, The Prince Charles HospitalBrisbaneQueenslandAustralia
| | - Karen Hay
- Greater Brisbane Clinical School, Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
- QIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
| | - Billingsley Kaambwa
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Anand Ganesan
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
- Department of Cardiovascular MedicineFlinders Medical CentreAdelaideSouth AustraliaAustralia
| | - Isuru Ranasinghe
- Greater Brisbane Clinical School, Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
- Department of Cardiology, The Prince Charles HospitalBrisbaneQueenslandAustralia
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Ziacchi M, Biffi M, Iacopino S, di Silvestro M, Marchese P, Miscio F, Caccavo VP, Zanotto G, Tomasi L, Dello Russo A, Donazzan L, Boriani G. REducing INFectiOns thRough Cardiac device Envelope: insight from real world data. The REINFORCE project. Europace 2023; 25:euad224. [PMID: 37490930 PMCID: PMC10637307 DOI: 10.1093/europace/euad224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/18/2023] [Indexed: 07/27/2023] Open
Abstract
AIMS Infections resulting from cardiac implantable electronic device (CIED) implantation are severely impacting on patients' and on health care systems. The use of TYRXTM absorbable antibiotic-eluting envelope has proven to decrease major CIED infections within 12 months of CIED surgery. The aim is to evaluate the impact of the envelope use on infection-related clinical events in a real-world contemporary patient population. METHODS AND RESULTS Data on patients undergoing CIED surgery were collected prospectively by participating centers of the One Hospital ClinicalService project. Patients were divided into two groups according to whether TYRXTM absorbable antibiotic-eluting envelope was used or not. Out of 1819 patients, 872 (47.9%) were implanted with an absorbable antibiotic-eluting envelope and included in the Envelope group and 947 (52.1%) patients who did not receive an envelope were included in the Control group. Compared to control, patients in the Envelope group had higher thrombo-embolic or hemorrhagic risk, higher BMI, lower LVEF and more comorbidities. During a mean follow-up of 1.4 years, the incidence of infection-related events was significantly higher in the control compared to the Envelope group (2.4% vs. 0.8%, P = 0.007). The five-year cumulative incidence of infection-related events was 8.1% in the control and 2.1% in the Envelope group (HR: 0.34, 95%CI: 0.14-0.80, P = 0.010). CONCLUSION In our analysis, the use of an absorbable antibiotic-eluting envelope in the general CIED population was associated with a lower risk of systemic and pocket infection.
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Affiliation(s)
- Matteo Ziacchi
- Institute of Cardiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Via Massarenti 9, 40125 Bologna, Italy
| | - Mauro Biffi
- Institute of Cardiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Via Massarenti 9, 40125 Bologna, Italy
| | | | | | | | | | | | | | | | | | - Luca Donazzan
- Cardiology Department, Ospedale San Maurizio, Bolzano, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
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Otome O, Wright A, Gunjaca V, Bowe S, Athan E. The Economic Burden of Infective Endocarditis due to Injection Drug Use in Australia: A Single Centre Study-University Hospital Geelong, Barwon Health, Victoria. Interdiscip Perspect Infect Dis 2022; 2022:6484960. [PMID: 36570593 PMCID: PMC9788891 DOI: 10.1155/2022/6484960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/13/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
Background Injection drug use (IDU) is a well-recognized risk factor for infective endocarditis (IE). Associated complications from IDU result in significant morbidity and mortality with substantial cost implications. The aim of this study was to determine the cost burden associated with the management of IE due to IDU (IE-IDU). Methods We used data collected prospectively on patients with a diagnosis of IE-IDU as part of the international collaboration on endocarditis (ICE). The cost of medical treatment was estimated based on diagnosis-related groups (DRG) and weighted inlier equivalent separation (WIES). Results There were 23 episodes from 21 patients in 12 years (2002 to 2014). The costing was done for 22 episodes due to data missing on 1 patient. The median age was 39 years. The gender distribution was equal. Heroin (71%) and methamphetamine (33%) were the most frequently used. 74% (17/23) required intensive care unit (ICU) admission. The median ICU length of stay (LOS) was 4 days (IQR (Interquartile range); 2 to 40 days) whilst median total hospital LOS was 40 days (IQR; 1 to 119 days). Twelve patients (52%) underwent valve replacement surgery. Mortality was 13% (3/23). The total medical cost for the 22 episodes is estimated at $1,628,359 Australian dollars (AUD). The median cost per episode was a median cost of $ 61363 AUD (IQR: $2806 to $266,357 AUD). We did not account for lost productivity and collateral costs attributed to concurrent morbidity. Conclusion Within the limitations of this small retrospective study, we report that the management of infective endocarditis caused by injection drug use can be associated with significant financial cost.
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Affiliation(s)
- Ohide Otome
- University of Western Australia, Perth, Australia
- SJOG Midland Public and Private Hospital, Midland, Australia
| | | | - Vanika Gunjaca
- University Hospital Geelong, Barwon Health, Geelong, Australia
| | - Steve Bowe
- Deakin Biostatistics Unit, Faculty of Health, School of Medicine, Deakin University, Geelong, Australia
| | - Eugene Athan
- University Hospital Geelong, Barwon Health, Geelong, Australia
- Deakin Biostatistics Unit, Faculty of Health, School of Medicine, Deakin University, Geelong, Australia
- Geelong Centre for Emerging Infectious Disease (GCEID), Geelong, Australia
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Kouijzer JJP, Noordermeer DJ, van Leeuwen WJ, Verkaik NJ, Lattwein KR. Native valve, prosthetic valve, and cardiac device-related infective endocarditis: A review and update on current innovative diagnostic and therapeutic strategies. Front Cell Dev Biol 2022; 10:995508. [PMID: 36263017 PMCID: PMC9574252 DOI: 10.3389/fcell.2022.995508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Infective endocarditis (IE) is a life-threatening microbial infection of native and prosthetic heart valves, endocardial surface, and/or indwelling cardiac device. Prevalence of IE is increasing and mortality has not significantly improved despite technological advances. This review provides an updated overview using recent literature on the clinical presentation, diagnosis, imaging, causative pathogens, treatment, and outcomes in native valve, prosthetic valve, and cardiac device-related IE. In addition, the experimental approaches used in IE research to improve the understanding of disease mechanisms and the current diagnostic pipelines are discussed, as well as potential innovative diagnostic and therapeutic strategies. This will ultimately help towards deriving better diagnostic tools and treatments to improve IE patient outcomes.
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Affiliation(s)
- Joop J. P. Kouijzer
- Thoraxcenter, Department of Biomedical Engineering, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Daniëlle J. Noordermeer
- Thoraxcenter, Department of Biomedical Engineering, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Wouter J. van Leeuwen
- Department of Cardiothoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Nelianne J. Verkaik
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Kirby R. Lattwein
- Thoraxcenter, Department of Biomedical Engineering, Erasmus MC University Medical Center, Rotterdam, Netherlands
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Han HC, Hawkins NM, Pearman CM, Birnie DH, Krahn AD. Epidemiology of cardiac implantable electronic device infections: incidence and risk factors. Europace 2021; 23:iv3-iv10. [PMID: 34051086 PMCID: PMC8221051 DOI: 10.1093/europace/euab042] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Indexed: 12/17/2022] Open
Abstract
Cardiac implantable electronic device (CIED) infection is a potentially devastating complication of CIED procedures, causing significant morbidity and mortality for patients. Of all CIED complications, infection has the greatest impact on mortality, requirement for re-intervention and additional hospital treatment days. Based on large prospective studies, the infection rate at 12-months after a CIED procedure is approximately 1%. The risk of CIED infection may be related to several factors which should be considered with regards to risk minimization. These include technical factors, patient factors, and periprocedural factors. Technical factors include the number of leads and size of generator, the absolute number of interventions which have been performed for the patient, and the operative approach. Patient factors include various non-modifiable underlying comorbidities and potentially modifiable transient conditions. Procedural factors include both peri-operative and post-operative factors. The contemporary PADIT score, derived from a large cohort of CIED patients, is useful for the prediction of infection risk. In this review, we summarize the key information regarding epidemiology, incidence and risk factors for CIED infection.
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Affiliation(s)
- Hui-Chen Han
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, Center for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathaniel M Hawkins
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, Center for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles M Pearman
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, Center for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada.,Unit of Cardiac Physiology, Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, Core Technology Facility, University of Manchester, Manchester M13 9XX, UK
| | - David H Birnie
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Andrew D Krahn
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, Center for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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