Factors associated with cardiac implantable electronic device‐related infections, New South Wales, 2016–21: a retrospective cohort study

Abstract

AbstractObjectivesTo quantify the rate of cardiac implantable electronic device (CIED)‐related infections and to identify risk factors for such infections.DesignRetrospective cohort study; analysis of linked hospital admissions and mortality data.Setting, participantsAll adults who underwent CIED procedures in New South Wales between 1 January 2016 and 30 June 2021 (public hospitals) or 30 June 2020 (private hospitals).Main outcome measuresProportions of patients hospitalised with CIED‐related infections (identified by hospital record diagnosis codes); risk of CIED‐related infection by patient, device, and procedural factors.ResultsOf 37 675 CIED procedures (23 194 men, 63.5%), 500 were followed by CIED‐related infections (median follow‐up, 24.9 months; interquartile range, 11.2–40.8 months), including 397 people (1.1%) within twelve months of their procedures, and 186 of 10 540 people (2.5%) at high risk of such infections (replacement or upgrade procedures; new cardiac resynchronisation therapy with defibrillator, CRT‐D). The overall infection rate was 0.50 (95% confidence interval [CI], 0.45–0.54) per 1000 person‐months; it was highest during the first month after the procedure (5.60 [95% CI, 4.89–6.42] per 1000 person‐months). The risk of CIED‐related infection was greater for people under 65 years of age than for those aged 65–74 years (adjusted hazard ratio [aHR], 1.71; 95% CI, 1.32–2.23), for people with CRT‐D devices than for those with permanent pacemakers (aHR, 1.46; 95% CI, 1.02–2.08), for people who had previously undergone CIED procedures (two or more v none: aHR, 1.51; 95% CI, 1.02–2.25) or had CIED‐related infections (aHR, 11.4; 95% CI, 8.34–15.7), or had undergone concomitant cardiac surgery (aHR, 1.62; 95% CI, 1.10–2.39), and for people with atrial fibrillation (aHR, 1.33; 95% CI, 1.11–1.60), chronic kidney disease (aHR, 1.54; 95% CI, 1.27–1.87), chronic obstructive pulmonary disease (aHR, 1.37; 95% CI, 1.10–1.69), or cardiomyopathy (aHR 1.60; 95% CI, 1.25–2.05).ConclusionsKnowledge of risk factors for CIED‐related infections can help clinicians discuss them with their patients, identify people at particular risk, and inform decisions about device type, upgrades and replacements, and prophylactic interventions.