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Rates of and factors associated with infection in 200 909 Medicare implantable cardioverter-defibrillator implants: results from the National Cardiovascular Data Registry.

Publication ,  Journal Article
Prutkin, JM; Reynolds, MR; Bao, H; Curtis, JP; Al-Khatib, SM; Aggarwal, S; Uslan, DZ
Published in: Circulation
September 23, 2014

BACKGROUND: The rate of implantable cardioverter-defibrillator (ICD) infections has been increasing faster than that of implantation. We sought to determine the rate and predictors of ICD infection in a large cohort of Medicare patients. METHODS AND RESULTS: Cases submitted to the ICD Registry from 2006 to 2009 were matched to Medicare fee-for-service claims data using indirect patient identifiers. ICD infections occurring within 6 months of hospital discharge after implantation were identified by ICD-9 codes. Logistic regression was used to examine factors associated with risk of ICD infection. Of 200 909 implants, 3390 patients (1.7%) developed an ICD infection. The infection rate was 1.4%, 1.5%, and 2.0% for single, dual, and biventricular ICDs, respectively (P<0.001). Generator replacement had a higher rate compared with initial implant (1.9% versus 1.6%, P<0.001). The factors associated with infection were adverse event during implant requiring reintervention (odds ratio [OR], 2.692; 95% confidence interval [CI], 2.304-3.145), previous valvular surgery (OR, 1.525; 95% CI, 1.375-1.692), reimplantation for device upgrade, malfunction, or manufacturer advisory (OR, 1.354; 95% CI, 1.196-1.533), renal failure on dialysis (OR, 1.342; 95% CI, 1.123-1.604), chronic lung disease (OR, 1.215; 95% CI, 1.125-1.312), cerebrovascular disease (OR, 1.172; 95% CI, 1.076-1.276), and warfarin (OR, 1.155; 95% CI, 1.060-1.257). CONCLUSIONS: Patients who developed an ICD infection were more likely to have had peri-ICD implant complications requiring early reintervention, previous valve surgery, device replacement for reasons other than battery depletion, and increased comorbidity burden. Efforts should be made to carefully consider when to reenter the pocket at any time other than battery replacement.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

September 23, 2014

Volume

130

Issue

13

Start / End Page

1037 / 1043

Location

United States

Related Subject Headings

  • United States
  • Risk Factors
  • Retrospective Studies
  • Renal Insufficiency
  • Registries
  • Medicare
  • Male
  • Lung Diseases
  • Logistic Models
  • Incidence
 

Citation

APA
Chicago
ICMJE
MLA
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Prutkin, J. M., Reynolds, M. R., Bao, H., Curtis, J. P., Al-Khatib, S. M., Aggarwal, S., & Uslan, D. Z. (2014). Rates of and factors associated with infection in 200 909 Medicare implantable cardioverter-defibrillator implants: results from the National Cardiovascular Data Registry. Circulation, 130(13), 1037–1043. https://doi.org/10.1161/CIRCULATIONAHA.114.009081
Prutkin, Jordan M., Matthew R. Reynolds, Haikun Bao, Jeptha P. Curtis, Sana M. Al-Khatib, Saurabh Aggarwal, and Daniel Z. Uslan. “Rates of and factors associated with infection in 200 909 Medicare implantable cardioverter-defibrillator implants: results from the National Cardiovascular Data Registry.Circulation 130, no. 13 (September 23, 2014): 1037–43. https://doi.org/10.1161/CIRCULATIONAHA.114.009081.
Prutkin JM, Reynolds MR, Bao H, Curtis JP, Al-Khatib SM, Aggarwal S, et al. Rates of and factors associated with infection in 200 909 Medicare implantable cardioverter-defibrillator implants: results from the National Cardiovascular Data Registry. Circulation. 2014 Sep 23;130(13):1037–43.
Prutkin, Jordan M., et al. “Rates of and factors associated with infection in 200 909 Medicare implantable cardioverter-defibrillator implants: results from the National Cardiovascular Data Registry.Circulation, vol. 130, no. 13, Sept. 2014, pp. 1037–43. Pubmed, doi:10.1161/CIRCULATIONAHA.114.009081.
Prutkin JM, Reynolds MR, Bao H, Curtis JP, Al-Khatib SM, Aggarwal S, Uslan DZ. Rates of and factors associated with infection in 200 909 Medicare implantable cardioverter-defibrillator implants: results from the National Cardiovascular Data Registry. Circulation. 2014 Sep 23;130(13):1037–1043.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

September 23, 2014

Volume

130

Issue

13

Start / End Page

1037 / 1043

Location

United States

Related Subject Headings

  • United States
  • Risk Factors
  • Retrospective Studies
  • Renal Insufficiency
  • Registries
  • Medicare
  • Male
  • Lung Diseases
  • Logistic Models
  • Incidence