Chronic Kidney Disease and Transvenous Cardiac Implantable Electronic Device Infection - Is there an Impact on Healthcare Utilization, Costs, Disease Progression and Mortality?

BACKGROUND AND AIMS

Cardiac implantable electronic device (CIED) infections are a burden to hospitals and costly for health care 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

This retrospective analysis used de-identified Medicare Fee for Service (FFS) claims to identify patients implanted with a CIED from July 2016-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.

RESULTS

A total of 584,543 patients had a CIED implant, of which 26% had CKD and 1.4% had a device infection. Average total days in hospital for infected patients was 23.5 days with CKD versus 14.5 days (p<.001) without. Average cost of infection was $121,756 with CKD versus $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 septicemia or severe sepsis than those without CKD (11.0% vs 4.6%, p<.001). After infection, CKD patients were more likely to experience CKD progression (HR 1.26, p <.001) and mortality (HR 1.89, p <.001).

CONCLUSION

CIED infection in patients with CKD was associated with more health care utilization, higher cost, greater disease progression, and greater mortality compared to patients without CKD.

Informations de copyright

© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.