The use of cardiac implantable electronic devices (CIED) is accompanied by an increase in device-related infections, especially for pacemakers, and the cost of treating those infections, length of stay, and mortality within 15 months of the procedure has been rising, researchers say.
Additionally, infections related to these devices provoked lengths of stay that were between 9.4 and 18.2 days longer than lengths of stay for patients who did not have infections.
Those were the findings from Muhammad R. Sohail, MD, of the Mayo Clinic College of Medicine in Rochester and colleagues at Johns Hopkins University, Catholic University of America and others. The report was published in Monday's Archives of Internal Medicine.
The researchers looked at a Medicare database of 200,219 fee-for-service patients admitted to a hospital during the 2007 calendar year for implantation, replacement, or revision of a cardiac device.
They found 5,817 developed an infection, which was associated with significant increases in adjusted admission mortality between 4.6% and 11.3%, and long-term mortality was 26.5% to 35.1% depending on the type of implant device.
In patients who developed infection, the total costs of admission were $28,676 to $53,349, depending on the device, an increase of between $14,360 and $16,498 per implant. Intensive care which was often required, and enhanced pharmacy services, made up 40% of the added cost.
Pacemakers seemed to carry the highest risk of infection, compared with implantable cardioverter-defibrillators or cardiac resynchronization therapy/defibrillator devices, the other types of CIEDs studied.
The researchers also noted that prior reports may have overestimated the cost-benefit ratio for some patients. "For example, recent cost-effectiveness analyses of ICD (implantable cardiac device) therapy are based on data from randomized trials that limited enrollment of patients older than 75 years. We believe Medicare beneficiary administrative data is a more appropriate tool to study the financial cost of CIED infections because the majority of CIED are implanted in older individuals."
The authors noted that their study period, 2007, captured more technologically advanced devices and implantation techniques, as well as more current guidelines, so the increased rates of infection can not be chalked up to older, less viable implants or antiquated practices and procedures.
Additionally, they said their cost estimates are probably low because "inpatient physicians' fees and required outpatient care are not captured."
The authors said that some of the added cost might be reduced by better detection.
"Strategies to shorten the time to explantation, including expedited diagnosis, could reduce intensive care expenses," they wrote. Also, patients should be carefully assessed for the requirement of external electrical support following explantation of the infected device, since up to 30% of patients may not require implantation of a new device."
In an accompanying editorial, Ronan Margey, MD, of the division of cardiology at Massachusetts General Hospital called the report "a warning siren to physicians to be sure ICD implantation is appropriate per professional society guidelines and to monitor patients at risk of developing infection closely and intervene promptly."
She added, "Furthermore, prevention is better than cure. To optimize prevention, active surveillance of all potential device recipients both before and after device implantation is essential."