National Trends in Healthcare-Associated Infections for Five Common Cardiovascular Conditions

Abstract

Healthcare-associated infections (HAI) are generally preventable causes of increased cost, morbidity, and mortality. Further, HAI carry penalties in the era of hospital value-based care. However, very little is known about the incidence and outcomes of HAI among patients hospitalized with common cardiovascular conditions. Using a national database, we identified adults aged ≥18 years hospitalized with 5 common cardiovascular conditions, including heart failure, acute myocardial infarction, coronary artery bypass grafting, cardiogenic shock, and atrial fibrillation or flutter. We assessed for temporal trends in incidence, cost, length of stay (LOS), and mortality associated with ventilator-associated pneumonia, catheter-associated urinary tract infections, central line-associated bloodstream infection, and Clostridium difficile infections. Between 2008 and 2015, we identified 159,021 hospitalizations ≥1 HAI (49.6% heart failure, 20.4% acute myocardial infarction, 10.5% coronary artery bypass grafting, 18.6% cardiogenic shock, and 11.9% atrial fibrillation or flutter). Clostridium difficile infections (75.4%) were the most common followed by catheter-associated urinary tract infections (15.1%), ventilator-associated pneumonia (7.9%), and central line-associated bloodstream infection (3.1%). Nearly half of the patients (46.3%) with HAI required discharge to a skilled care facility compared with 15.7% of patients who did not. After propensity matching, HAI remained associated with an increased LOS (4.9 vs 9.6 days, p <0.0001), total hospital charges ($79,227 vs $50,699, p <0.0001), and in-hospital mortality (13% vs 10.4%, p <0.0001) compared with patients who did not acquire a HAI. In conclusion, patients with cardiovascular disease acquiring a HAI had substantially higher costs, LOS, and mortality.

Figure 1.

Incidence per 100,000 hospitalizations.

Figure 2.

Trends in hospital charges by insurance type in a fully propensity/risk adjusted model. p-trends presented of geometric means after log transforming the values.

Figure 3.

In-hospital mortality in our unadjusted and fully propensity/risk adjusted model for 3 different time periods All p values <0.0001 except * = 0.001, odds ratio (confidence interval) for adjusted models 2008 to 2009 cohort, 2011 to 2012 cohort, and 2014 to 2015 cohort 1.6 (1.4 to 1.8), 1.2 (1.1 to 1.3), and 1.2 (1.1 to 1.3), respectively.