16-Year Trends in the Infection Burden for Pacemakers and Implantable Cardioverter-Defibrillators in the United States

Division of Cardiology, Department of Medicine, Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA 19107, USA.
Journal of the American College of Cardiology (Impact Factor: 16.5). 08/2011; 58(10):1001-6. DOI: 10.1016/j.jacc.2011.04.033
Source: PubMed


We analyzed the infection burden associated with the implantation of cardiac implantable electrophysiological devices (CIEDs) in the United States for the years 1993 to 2008.
Recent data suggest that the rate of infection following CIED implantation may be increasing.
The Nationwide Inpatient Sample (NIS) discharge records were queried between 1993 and 2008 using the 9th Revision of the International Classification of Diseases (ICD-9-CM). CIED infection was defined as either: 1) ICD-9 code for device-related infection (996.61) and any CIED procedure or removal code; or 2) CIED procedure code along with systemic infection. Patient health profile was evaluated by coding for renal failure, heart failure, respiratory failure, and diabetes mellitus. The infection burden and patient health profile were calculated for each year, and linear regression was used to test for changes over time.
During the study period (1993 to 2008), the incidence of CIED infection was 1.61%. The annual rate of infections remained constant until 2004, when a marked increase was observed, which coincided with an increase in the incidence of major comorbidities. This was associated with a marked increase in mortality and in-hospital financial charges.
The infection burden associated with CIED implantation is increasing over time and is associated with prolonged hospital stays and high financial costs.

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Available from: Behzad Pavri,
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    • "The number of implanted cardiac implantable electronic devices (CIED) has increased over the recent years [1]. This trend is caused by a wider range of indications [2] [3]. "
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    • "The use of pacemakers has increased in the last 15 years [7,8]. Likewise the number of elderly persons with chronic illness is growing. "
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    • "Lead extraction is a necessary procedure for the troubleshooting of cardiac implantable electrical devices (CIEDs) and has increased year on year. It is estimated that 10,000–15,000 leads are extracted annually worldwide, and it is supposed that the reason for the increase in lead extraction is the increase in infection rate of CIEDs [1] [2]. Also, extraction for redundant leads has increased recently [3], reflecting both an increasing demand for extraction of these leads and an increasing confidence in extractors. "

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