Arrhythmias and conduction disturbances
Predictors of Mortality in Patients With Cardiovascular Implantable Electronic Device Infections

A poster abstract with the preliminary results of this study was presented at the Annual Meeting of Infectious Diseases Society of America, Boston, Massachusetts, October 2011.
https://doi.org/10.1016/j.amjcard.2012.11.052Get rights and content

Infection reduces survival in cardiovascular implantable electronic device (CIED) recipients. However, the clinical predictors of short- and long-term mortality in patients with CIED infection are not well understood. We retrospectively reviewed all patients with CIED infection who were admitted to Mayo Clinic from January 1991 to December 2008. Survival data were obtained from the medical records and the United Sates Social Security Index. The purported risk factors for short-term (30-day) and long-term (>30-day) mortality were analyzed using univariate and multivariate models. Overall, 415 cases of CIED infection were identified during the study period. The mean follow-up duration for the 243 patients who were alive at the last follow-up visit was 6.9 years. In a multivariate model, heart failure (odds ratio 9.31, 95% confidence interval 2.08 to 41.67), corticosteroid therapy (odds ratio 4.04, 95% confidence interval 1.40 to 11.60), and presentation with CIED-related infective endocarditis (odds ratio 5.60, 95% confidence interval 2.25 to 13.92) were associated with increased short-term mortality. The factors associated with long-term mortality in the multivariate model included patient age (hazard ratio 1.20, 95% confidence interval 1.06 to 1.36), heart failure (hazard ratio 2.01, 95% confidence interval 1.42 to 2.86), metastatic malignancy (hazard ratio 5.99, 95% confidence interval 1.67 to 21.53), corticosteroid therapy (hazard ratio 1.97, 95% confidence interval 1.22 to 3.18), renal failure (hazard ratio 1.94, 95% confidence interval 1.37 to 2.74), and CIED-related infective endocarditis (hazard ratio 1.68, 95% confidence interval 1.17 to 2.41). In conclusion, these data suggest that the development of CIED-related infective endocarditis and the presence of co-morbid conditions are associated with increased short- and long-term mortality in patients with CIED infection.

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Methods

We retrospectively reviewed all patients with CIED infection who were admitted to Mayo Clinic (Rochester, Minnesota) from January 1, 1991 to December 31, 2008. The cases of CIED infection were identified from the Mayo Clinic Heart Rhythm Device Database, the surgical index, and the computerized central diagnostic index.5 The Mayo Clinic institutional review board reviewed and approved the study proposal.

CIED infection was defined using criteria previously described by our group.2, 5, 6 Cases of

Results

Overall, 415 patients with CIED infection were identified from January 1, 1991 to December 31, 2008. The clinical patient characteristics are summarized in Table 1. Of the 415 patients, 1 patient who was alive at hospital discharge was excluded from the analysis of short-term mortality because the 30-day follow-up data were not available. Of the remaining 414 patients, 23 (5.6%) died within 30 days after admission and 391 (94.4%) were alive at 30 days after admission. The univariate

Discussion

Our investigation is one of the largest to analyze the risk factors associated with short- and long-term mortality in patients with CIED infection. Moreover, using data from our multivariate models, we devised a simple and an easy-to-use prediction tool for short-term mortality (Table 3) that includes readily available clinical information, such as the presence or absence of heart failure, history of corticosteroid therapy, and echocardiographic evidence of CIED-IE. We believe this model will

Acknowledgment

We thank Joanne E. Spencer, RN, and Nancy Acker, RN, for their important contributions in data collection.

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This work was supported by a Career Development Award to Dr. Sohail from the Department of Medicine, Mayo Foundation for Medical Education and Research (Rochester, Minnesota).

See page 879 for disclosure information.

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