Impact of timing of treatment for cardiac implantable electronic device infections on healthcare utilization and expenditures.

AIMS: Early extraction for cardiovascular implantable electronic device (CIED) infections has been associated with longer survival, while the impact on healthcare utilization is unknown. The aim is to evaluate the impact of early extraction on healthcare expenditures and utilization. METHODS AND RESULTS: Using 100% Medicare fee-for-service data with Part D from 1/1/2006 through 12/31/2019, patients with a de novo CIED implant and CIED infection > 12 months after implant were identified to analyse healthcare utilization according to the occurrence and timing of extraction. The CIED infection was defined as (i) a claim for endocarditis or infection of a device implant and (i) documented antibiotic therapy. Among 9594 patients with CIED infection [median age 75 years (25th, 75th; 67, 81), 39.9% women], 7819 (81.5%) patients did not undergo extraction within 30 days, 1277 (13.3%) patients had extraction in <7 days, and 498 (5.2%) patients underwent extraction between 7 and 30 days. Following multivariable adjustment, extraction in less than 7 days (adjusted hazard ratio 0.79, 95% confidence interval 0.72-0.85, P < 0.001) of CIED infection was associated with lower all-cause hospitalization in follow-up. Healthcare expenditures in the year following CIED infection were higher among the patients without extraction within 30 days (median $63 425; 25th, 75th $22,853, $120 273) and were lowest among patients who underwent extraction < 7 days after diagnosis of CIED infection (median $36 824; 25th, 75th $12,748, $77 772). CONCLUSION: Extraction was associated with lower hospitalization and lower healthcare expenditures in the year following CIED infection management period. Early extraction was associated with optimal healthcare utilization and expenditures.

Duke Scholars

Author Donald Dale Hegland Medicine, Cardiology

Author Robert Kenneth Lewis Medicine, Cardiology

Author Sean Pokorney Medicine, Cardiology

Author Christopher Bull Granger Medicine, Cardiology

Author Jonathan Paul Piccini Sr. Medicine, Cardiology