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Cardiovascular implantable electronic device complications common

Complications associated with cardiovascular implantable electronic devices are common and vary significantly among hospitals, suggesting that interventions are needed to address quality of care across institutions, according to study results published in the Annals of Internal Medicine.

“Although effective for treating heart rhythm abnormalities, [cardiovascular implantable electronic devices (CIEDs)] are associated with early device-related complications, such as infection, pneumothorax and lead dislodgement,” Isuru Ranasinghe, MBChB, MMed, PhD, of the Basil Hetzel Institute for Translational Research at the University of Adelaide and Central Adelaide Local Health Network in Australia, and colleagues wrote.

“Despite the widespread use of CIEDs, little is known about differences in CIED complications among institutions, which may suggest discrepancies in care quality,” they continued.

Researchers conducted a cohort study using hospitalization data from Australia and New Zealand that included all hospitalizations from 174 public and private hospitals. Patients who were given a new CIED between 2010 and 2015 who were aged at least 18 years were eligible for inclusion in the study. Researchers compared outcomes between those who received two types of CIEDs: permanent pacemakers and implantable cardioverter-defibrillators.

Hospitalization data were used to identify complications during hospitalization or within 90 days of discharge. Complications included death, device-related reoperation, postprocedural shock, rehospitalization, a mechanical complication, and venous obstruction or thromboembolism.

A total of 81,304 patients with new CIEDs were included in the study; 65,711 received a permanent pacemaker and 15,593 received an implantable cardioverter-defibrillator. Major complications occurred in 6,664 (8.2%) participants.

The crude risk for major complications was higher among those who received implantable cardioverter-defibrillators (10.04%) than permanent pacemakers (7.76%), but 76.5% of all complications were found in those with permanent pacemakers.

In the 88 hospitals that implanted a minimum of 25 CIEDs, the median risk-standardized complication rate was 8.1%, with rates varying from 5.3% to 14.3%. Researchers found that risk-standardized complication rates varied significantly among the 96 hospitals that placed at least 25 permanent pacemakers (median = 7.9%; 5.4% to 12.9%) and the 68 hospitals who placed at least 25 implantable cardioverter-defibrillators (median = 9.7%; 6.2% to 16.9%). When elective procedures were included, the risk-standardized complication rate had similar variation (median = 7.4%; 4.7% to 13%).

Researchers noted that future interventions to address CIED complications should target permanent pacemakers, as they were more common and resulted in nearly three quarters of all CIED complications.

“The present data are important for clinical decision making and crucial in facilitating the informed consent process between patients and their physicians,” Jorge A. Wong, MD, MPH, and P.J. Devereaux, MD, PhD, of McMaster University, Hamilton, Ontario, Canada, wrote in an editorial accompanying the study. “Furthermore, the current report identifies an important gap in the quality of CIED care among institutions, which will require integrated clinical and policy-focused interventions to optimize care.” – by Erin Michael

Disclosures: Devereaux reports grants from Abbott Diagnostics, Boehringer Ingelheim, Philips Healthcare, Roche Diagnostics and Siemens outside the submitted work. Ranasinghe reports grants from The HCF of Australia Research Foundation, The Hospital Research Foundation, and the National Heart Foundation of Australia during the conduct of the study. Wong reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.