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Device-related infection in de novo transvenous implantable cardioverter-defibrillator Medicare patients

El-Chami, MF; Jacobsen, CM; Griffiths, RI; Hansen, LK; Wold, N; Amorosi, SL; Stivland, TM; ... Baddour, LM; + view all (2021) Device-related infection in de novo transvenous implantable cardioverter-defibrillator Medicare patients. Heart Rhythm 10.1016/j.hrthm.2021.04.014. (In press). Green open access

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Abstract

BACKGROUND: Cardiac device infection is a serious complication of implantable cardioverter-defibrillator (ICD) placement and requires complete device removal with accompanying antimicrobial therapy for durable cure. Recent guidelines have highlighted the need to better identify patients at high risk of infection to assist in device selection. OBJECTIVE: To estimate the prevalence of infection in de novo transvenous (TV) ICD implants and assess factors associated with infection risk in a Medicare population. METHODS: A retrospective cohort study was conducted using 100% Medicare administrative and claims data to identify patients who underwent de novo TV-ICD implantation (7/2016-12/2017). Infection within 720 days of implantation was identified using ICD-10 codes. Baseline factors associated with infection were identified by univariable logistic regression analysis of all variables of interest, including conditions in Charlson and Elixhauser comorbidity indices, followed by stepwise selection criteria with a p≤0.25 for inclusion in a multivariable model and a backwards, stepwise elimination process with p≤0.1 to remain in the model. A time-to-event analysis was also conducted. RESULTS: Among 26,742 patients with de novo TV-ICD, 519 (1.9%) developed an infection within 720 days post-implant. While more than half (54%) of infections occurred during the first 90 days, 16% of infections occurred after 365 days. Multivariable analysis revealed several significant predictors of infection: age <70 years, renal disease with dialysis, and complicated diabetes mellitus. CONCLUSION: The rate of de novo TV-ICD infection was 1.9% and identified risk factors associated with infection may be useful in device selection.

Type: Article
Title: Device-related infection in de novo transvenous implantable cardioverter-defibrillator Medicare patients
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.hrthm.2021.04.014
Publisher version: https://doi.org/10.1016/j.hrthm.2021.04.014
Language: English
Additional information: Copyright © 2021 Heart Rhythm Society. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Keywords: device, implantable cardioverter-defibrillator, infection, prevalence, risk factors
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Clinical Science
URI: https://discovery.ucl.ac.uk/id/eprint/10127307
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