The burden and risk factors for infection of transvenous cardiovascular implantable electronic device: A nationwide cohort study

Pil Sung Yang, Jaehan Jeong, So Jeong You, Hee Tae Yu, Tae Hoon Kim, Jung Hoon Sung, Sang Soo Lee, Hyung Deuk Park, Boyoung Joung

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background and Objectives: There are limited published data on the incidence and cost associated with cardiac implantable electrical device (CIED) infection for Asian patients. We analyzed the infection burden associated with the implantation of CIEDs in Korea. Methods: In the Health Insurance Review & Assessment Service (HIRA) database during the period from January 1, 2014 to December 31, 2016, we identified 16,908 patients with CIED implantation. CIED infection was defined as either: 1) Infection-related diagnosis code by the Korean Standard Classification of Diseases after any CIED procedure; or 2) CIED removal along with systemic infection. Results: The proportions of first implantation and replacement were 77.6% and 22.4%, respectively. During the follow-up period of 17.1±10.6 months, a total of 462 patients had CIED infection with incidence of 1.95 per 100 person-years with higher infection rate in replacement than first implantation (3.97 vs. 1.4 per 100 person-years, p<0.001). The average cost per person was US$ 16,584 (pacemaker, $13,736; implantable cardioverter defibrillator, $28,402; cardiac resynchronization therapy, $29,674). The risk factors of CIED infection were generator replacement (adjusted hazard ratio [aHR], 3.14; 95% confidence interval [CI], 2.60–3.78), diabetes mellitus (aHR, 1.94; 95% CI, 1.58–2.38), and congestive heart failure (aHR, 1.86; 95% CI, 1.51–2.28). Conclusions: The rate of CIED infection in Korea was 1.95 per 100 person-years with average cost of US$ 16,584. The most important risk factor was generator replacement. This result suggests that generator replacement should be performed cautiously to avoid CIED infection.

Original languageEnglish
Pages (from-to)742-752
Number of pages11
JournalKorean Circulation Journal
Volume49
Issue number8
DOIs
Publication statusPublished - 2019 Jan 1

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Cardiovascular Infections
Cohort Studies
Equipment and Supplies
Infection
Confidence Intervals
Korea
Costs and Cost Analysis
Device Removal
Cardiac Resynchronization Therapy
Implantable Defibrillators
Incidence
Health Insurance
Diabetes Mellitus

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Yang, Pil Sung ; Jeong, Jaehan ; You, So Jeong ; Yu, Hee Tae ; Kim, Tae Hoon ; Sung, Jung Hoon ; Lee, Sang Soo ; Park, Hyung Deuk ; Joung, Boyoung. / The burden and risk factors for infection of transvenous cardiovascular implantable electronic device : A nationwide cohort study. In: Korean Circulation Journal. 2019 ; Vol. 49, No. 8. pp. 742-752.
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title = "The burden and risk factors for infection of transvenous cardiovascular implantable electronic device: A nationwide cohort study",
abstract = "Background and Objectives: There are limited published data on the incidence and cost associated with cardiac implantable electrical device (CIED) infection for Asian patients. We analyzed the infection burden associated with the implantation of CIEDs in Korea. Methods: In the Health Insurance Review & Assessment Service (HIRA) database during the period from January 1, 2014 to December 31, 2016, we identified 16,908 patients with CIED implantation. CIED infection was defined as either: 1) Infection-related diagnosis code by the Korean Standard Classification of Diseases after any CIED procedure; or 2) CIED removal along with systemic infection. Results: The proportions of first implantation and replacement were 77.6{\%} and 22.4{\%}, respectively. During the follow-up period of 17.1±10.6 months, a total of 462 patients had CIED infection with incidence of 1.95 per 100 person-years with higher infection rate in replacement than first implantation (3.97 vs. 1.4 per 100 person-years, p<0.001). The average cost per person was US$ 16,584 (pacemaker, $13,736; implantable cardioverter defibrillator, $28,402; cardiac resynchronization therapy, $29,674). The risk factors of CIED infection were generator replacement (adjusted hazard ratio [aHR], 3.14; 95{\%} confidence interval [CI], 2.60–3.78), diabetes mellitus (aHR, 1.94; 95{\%} CI, 1.58–2.38), and congestive heart failure (aHR, 1.86; 95{\%} CI, 1.51–2.28). Conclusions: The rate of CIED infection in Korea was 1.95 per 100 person-years with average cost of US$ 16,584. The most important risk factor was generator replacement. This result suggests that generator replacement should be performed cautiously to avoid CIED infection.",
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The burden and risk factors for infection of transvenous cardiovascular implantable electronic device : A nationwide cohort study. / Yang, Pil Sung; Jeong, Jaehan; You, So Jeong; Yu, Hee Tae; Kim, Tae Hoon; Sung, Jung Hoon; Lee, Sang Soo; Park, Hyung Deuk; Joung, Boyoung.

In: Korean Circulation Journal, Vol. 49, No. 8, 01.01.2019, p. 742-752.

Research output: Contribution to journalArticle

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T1 - The burden and risk factors for infection of transvenous cardiovascular implantable electronic device

T2 - A nationwide cohort study

AU - Yang, Pil Sung

AU - Jeong, Jaehan

AU - You, So Jeong

AU - Yu, Hee Tae

AU - Kim, Tae Hoon

AU - Sung, Jung Hoon

AU - Lee, Sang Soo

AU - Park, Hyung Deuk

AU - Joung, Boyoung

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background and Objectives: There are limited published data on the incidence and cost associated with cardiac implantable electrical device (CIED) infection for Asian patients. We analyzed the infection burden associated with the implantation of CIEDs in Korea. Methods: In the Health Insurance Review & Assessment Service (HIRA) database during the period from January 1, 2014 to December 31, 2016, we identified 16,908 patients with CIED implantation. CIED infection was defined as either: 1) Infection-related diagnosis code by the Korean Standard Classification of Diseases after any CIED procedure; or 2) CIED removal along with systemic infection. Results: The proportions of first implantation and replacement were 77.6% and 22.4%, respectively. During the follow-up period of 17.1±10.6 months, a total of 462 patients had CIED infection with incidence of 1.95 per 100 person-years with higher infection rate in replacement than first implantation (3.97 vs. 1.4 per 100 person-years, p<0.001). The average cost per person was US$ 16,584 (pacemaker, $13,736; implantable cardioverter defibrillator, $28,402; cardiac resynchronization therapy, $29,674). The risk factors of CIED infection were generator replacement (adjusted hazard ratio [aHR], 3.14; 95% confidence interval [CI], 2.60–3.78), diabetes mellitus (aHR, 1.94; 95% CI, 1.58–2.38), and congestive heart failure (aHR, 1.86; 95% CI, 1.51–2.28). Conclusions: The rate of CIED infection in Korea was 1.95 per 100 person-years with average cost of US$ 16,584. The most important risk factor was generator replacement. This result suggests that generator replacement should be performed cautiously to avoid CIED infection.

AB - Background and Objectives: There are limited published data on the incidence and cost associated with cardiac implantable electrical device (CIED) infection for Asian patients. We analyzed the infection burden associated with the implantation of CIEDs in Korea. Methods: In the Health Insurance Review & Assessment Service (HIRA) database during the period from January 1, 2014 to December 31, 2016, we identified 16,908 patients with CIED implantation. CIED infection was defined as either: 1) Infection-related diagnosis code by the Korean Standard Classification of Diseases after any CIED procedure; or 2) CIED removal along with systemic infection. Results: The proportions of first implantation and replacement were 77.6% and 22.4%, respectively. During the follow-up period of 17.1±10.6 months, a total of 462 patients had CIED infection with incidence of 1.95 per 100 person-years with higher infection rate in replacement than first implantation (3.97 vs. 1.4 per 100 person-years, p<0.001). The average cost per person was US$ 16,584 (pacemaker, $13,736; implantable cardioverter defibrillator, $28,402; cardiac resynchronization therapy, $29,674). The risk factors of CIED infection were generator replacement (adjusted hazard ratio [aHR], 3.14; 95% confidence interval [CI], 2.60–3.78), diabetes mellitus (aHR, 1.94; 95% CI, 1.58–2.38), and congestive heart failure (aHR, 1.86; 95% CI, 1.51–2.28). Conclusions: The rate of CIED infection in Korea was 1.95 per 100 person-years with average cost of US$ 16,584. The most important risk factor was generator replacement. This result suggests that generator replacement should be performed cautiously to avoid CIED infection.

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