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

• Published in: Europace (London, England) Vol. 26; no. 7
• Main Authors: Wright, David J, Trucco, María Emilce, Zhou, Jiani, Wolff, Claudia, Holbrook, Reece, Margetta, Jamie, El-Chami, Mikhael F
• Format: Journal Article
• Language: English
• Published: UK Oxford University Press 02.07.2024; Oxford Publishing Limited (England)
• Subjects: Aged; Aged, 80 and over; Chronic infection; Clinical Research; Comorbidity; Coronary artery disease; Costs; Defibrillators, Implantable - adverse effects; Defibrillators, Implantable - economics; Disease Progression; Female; Generalized linear models; Health care; Health Care Costs - statistics & numerical data; Health services utilization; Heart diseases; Humans; Infections; Kidney diseases; Length of Stay - economics; Length of Stay - statistics & numerical data; Male; Medicare - economics; Mortality; Pacemaker, Artificial - adverse effects; Pacemaker, Artificial - economics; Pacemaker, Artificial - statistics & numerical data; Patient Acceptance of Health Care - statistics & numerical data; Patients; Prosthesis-Related Infections - economics; Prosthesis-Related Infections - mortality; Renal Insufficiency, Chronic - economics; Renal Insufficiency, Chronic - mortality; Renal Insufficiency, Chronic - therapy; Retrospective Studies; Sepsis; Septicemia; United States - epidemiology; United States; CIED infection; Costs; Chronic kidney disease; Healthcare resources; Mortality; Disease progression
• ISSN: 1099-5129; 1532-2092; 1532-2092
• DOI: 10.1093/europace/euae169

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. Graphical Abstract Graphical Abstract