title: Increased long-term mortality in patients with cardiovascular implantable electronic device infections.
abstract: BACKGROUND
  Device infection is associated with increased mortality in patients receiving cardiovascular implantable electronic device (CIED) therapy. However, long-term mortality associated with CIED infections has not been systematically analyzed in larger studies. This study sought to determine the long-term mortality associated with CIED infection in a large cohort of Medicare beneficiaries.
  
  
  METHODS
  We used a retrospective study design to analyze 3-year mortality in 200,219 Medicare fee-for-service patients admitted for CIED generator implantation, replacement, or revision between January 1, 2007 and December 31, 2007. Multivariate analysis adjusting for age, sex, race, and 28 comorbidities was performed to determine the relative risk (RR) of death in the 12 quarters following CIED infection.
  
  
  RESULTS
  Patients with CIED infection, compared to device recipients without infection, had increased mortality that persisted for at least 3 years after the admission quarter for all device types: pacemakers (PMs: 53.8% vs 33%; P < 0.001), implantable cardioverter defibrillator (ICD: 47.7% vs 31.6%; P < 0.001), and cardiac resynchronization therapy-defibrillator (CRT-D: 50.8% vs 36.5%; P < 0.001). After adjusting for patient demographics and comorbidities, significantly increased RR of death following CIED infection persisted for at least 3 years following PM infection, and for at least 2 years with single- and dual-chamber ICD infection.
  
  
  CONCLUSIONS
  CIED recipients who develop device infection have increased, device-dependent, long-term mortality even after successful treatment of infection. The etiology of this persistent increased risk of death associated with CIED infection is unknown and merits further investigation.
authors.affiliation: Divisions of Infectious Diseases and Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Rizwan Sohail
authors.forename: Charles A
authors.initials: CA
authors.lastname: Henrikson
authors.forename: Mary
authors.initials: M
authors.lastname: Jo Braid-Forbes
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Forbes
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Lerner
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D016459:Prosthesis-Related Infections / Q000401:mortality*; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
keywords: cardiac resynchronization therapy; cardiovascular implantable electronic device; implantable cardioverter defibrillator; infection; mortality; pacemaker