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. 2024 Jul 2;26(7):euae169.
doi: 10.1093/europace/euae169.

Chronic kidney disease and transvenous cardiac implantable electronic device infection-is there an impact on healthcare utilization, costs, disease progression, and mortality?

David J Wright  1 , María Emilce Trucco  2 , Jiani Zhou  3 , Claudia Wolff  4 , Reece Holbrook  3 , Jamie Margetta  3 , Mikhael F El-Chami  5
Affiliations

Chronic kidney disease and transvenous cardiac implantable electronic device infection-is there an impact on healthcare utilization, costs, disease progression, and mortality?

David J Wright et al. Europace. .

Abstract

Aims: Cardiac implantable electronic device (CIED) infections are a burden to hospitals and costly for healthcare systems. Chronic kidney disease (CKD) increases the risk of CIED infections, but its differential impact on healthcare utilization, costs, and outcomes is not known.

Methods and results: This retrospective analysis used de-identified Medicare Fee-for-Service claims to identify patients implanted with a CIED from July 2016 to December 2020. Outcomes were defined as hospital days and costs within 12 months post-implant, post-infection CKD progression, and mortality. Generalized linear models were used to calculate results by CKD and infection status while controlling for other comorbidities, with differences between cohorts representing the incremental effect associated with CKD. A total of 584 543 patients had a CIED implant, of which 26% had CKD and 1.4% had a device infection. The average total days in hospital for infected patients was 23.5 days with CKD vs. 14.5 days (P < 0.001) without. The average cost of infection was $121 756 with CKD vs. $55 366 without (P < 0.001), leading to an incremental cost associated with CKD of $66 390. Infected patients with CKD were more likely to have septicaemia or severe sepsis than those without CKD (11.0 vs. 4.6%, P < 0.001). After infection, CKD patients were more likely to experience CKD progression (hazard ratio 1.26, P < 0.001) and mortality (hazard ratio 1.89, P < 0.001).

Conclusion: Cardiac implantable electronic device infection in patients with CKD was associated with more healthcare utilization, higher cost, greater disease progression, and greater mortality compared to patients without CKD.

Keywords: CIED infection; Chronic kidney disease; Costs; Disease progression; Healthcare resources; Mortality.

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Conflict of interest statement

Conflict of interest: D.J.W. has received research grants and consultancy fees from Medtronic and Boston Scientific and educational fees from Abbot. M.E.T. has received speaker’s fees from Abbot, Biotronik, Boston Scientific, Medtronic, and Microport CRM. J.Z., C.W., R.H., and J.M. are employees of Medtronic, Inc. M.F.E.-C. has received consultant fees from Medtronic and Boston Scientific.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Attrition diagram of study cohort. CIED, cardiac implantable electronic device; CRT-D, cardiac resynchronization therapy defibrillator; CRT-P, cardiac resynchronization therapy pacemaker; ICD, implantable cardioverter-defibrillator; PPM, permanent pacemaker.
Figure 2
Figure 2
Cohort construction for cost difference analysis. CKD, chronic kidney disease.
Figure 3
Figure 3
Healthcare costs in patients with CIED infection. CIED, cardiac implantable electronic device; CRT, cardiac resynchronization therapy; ICD, implantable cardioverter-defibrillator; PPM, permanent pacemaker, CKD, chronic kidney disease.
Figure 4
Figure 4
Measures of severity of CIED infection by CKD status. CIED, cardiac implantable electronic device; CKD, chronic kidney disease.
Figure 5
Figure 5
Cumulative incidence of CKD progression in patients with CIED by infection status. CIED, cardiac implantable electronic device; CKD, chronic kidney disease.
Figure 6
Figure 6
Chronic kidney disease progression in patients with CIED by device type. CRT-D, cardiac resynchronization therapy defibrillator; CRT-P, cardiac resynchronization therapy pacemaker; ICD, implantable cardioverter-defibrillator; PPM, permanent pacemaker; CKD, chronic kidney disease.
Figure 7
Figure 7
Mortality by CKD and infection status. CIED, cardiac implantable electronic device; CKD, chronic kidney disease.
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