Early detection, treatment of cardiac implantable device infections may reduce death risk
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Key takeaways:
- Infection after receiving a cardiac implantable electronic device was most common within the first 3 months.
- Patients with early systemic and delayed localized infections were at greater mortality risk.
Cardiac implantable electronic device infections are most common within the first months after a procedure, decreasing significantly after the initial 3 months, data show.
In an analysis of more than 19,000 patients who received a cardiac implantable electronic device (IED), those with early localized infections were not at higher risk for all-cause mortality. However, patients with early systemic infections and delayed localized infections were at higher risk for mortality, and those with delayed systemic infections were at greatest risk.
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“To date, there is little prospective information regarding the timing of cardiac IED infections within the first 12 months after cardiac IED procedures,” Andrew D. Krahn, MD, FHRS, head of the division of cardiology at the University of British Columbia in Vancouver, and colleagues wrote in JAMA Cardiology. “Patient mortality associated with cardiac IED infections is also substantial. In-hospital mortality ranges between 5% and 10%, whereas 12-month all-cause mortality ranges between 15% and 30%. Although the extent of infection is associated with all-cause mortality for patients with cardiac IED infections, the association between infection timing and mortality has yet to be elucidated.”
In a prospective, observational study, Krahn and colleagues analyzed data from 19,559 patients from 28 centers across Canada and the Netherlands who received cardiac IEDs, 177 of whom developed an infection. The mean age of patients was 68.7 years; 74.6% were men. Researchers assessed the timing of infection, defined as early (first 3 months) or delayed (3 to 12 months) and the extent of infection, defined as localized or systemic, to determine risk for all-cause mortality associated with cardiac IED infections.
The cumulative incidence of infection was 0.6%, 0.7%, and 0.9% within 3, 6 and 12 months, respectively. Infection rates were highest during the first 3 months after the procedure (0.21% per month).
Compared with patients who did not develop infection after receiving a cardiac IED, those with early localized infections were not at higher risk for all-cause mortality, with no deaths observed at 30 days (P = .43). However, patients with early systemic and delayed localized infections had an approximately threefold increase in mortality at 30 days, with an adjusted HR of 2.88 for early systemic infections (95% CI, 1.48-5.61; P = .002) and an adjusted HR of 3.57 for delayed localized infections (95% CI, 1.33-9.57; P = .01). The risk increased to a 9.3-fold risk for death for those with delayed systemic infections (aHR = 9.3; 95% CI, 3.82-22.65; P < .001).
“Early localized infections are not associated with an increase in mortality,” the researchers wrote. “Early systemic infections and delayed localized infections are associated with an increase in mortality, whereas delayed systemic infections are associated with the greatest risk of mortality. Future studies should consider the potential relevance of infection timing and extent with respect to outcomes. The early detection and treatment of cardiac IED infections is important in reducing mortality associated with this complication.”
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