Heart infection involving ICD associated with high rate of complications, risk of death
Patients with infective endocarditis involving implanted cardiac devices experience a high rate of complications such as valve infections, heart failure, and persistent bacteremia, and high in-hospital and 1-year mortality rates, particularly if there is valve involvement, according to a study in the April 25 issue of JAMA.
"Cardiac electronic devices, including permanent pacemakers and implantable cardioverter-defibrillators (ICDs), are increasingly implanted worldwide, with estimates of more than 4.2 million patients with a permanent pacemaker or ICD implanted in the United States between 1993 and 2008. Cardiac device infection is a serious, emerging disease with a 210 percent increase in incidence between 1993 and 2008. In-hospital charges for this complication are estimated to be at least U.S. $146,000 per case," according to background information in the study. "The management of cardiac device infective endocarditis (CDIE) is complex and usually requires prolonged antibiotic therapy, percutaneous or surgical removal of the device, and possible device reimplantation."
Eugene Athan, M.D., of Barwon Health, Geelong, Australia, and colleagues conducted a study to examine the characteristics and outcome of CDIE with attention to health care-associated infection and to determine prognostic factors associated with in-hospital and 1-year mortality and outcomes following device removal. The study, which used data from the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS), was conducted from June 2000 through August 2006 in 61 centers in 28 countries.
Cardiac device infective endocarditis was diagnosed in 177 (6.4 percent) of the total cohort of 2,760 patients with definite infective endocarditis, including 152 (85.9 percent) patients with a permanent pacemaker, 21 (11.9 percent) patients with an ICD, and 4 (2.3 percent) patients with device type not specified. Patients were predominantly men (74.0 percent), with a median (midpoint) age of 71 years. Blood cultures were positive in 149 patients (84.2 percent), and isolates were predominantly staphylococcal (Staphylococcus aureus, 35.0 percent; coagulase-negative staphylococci, 31.6 percent).
The researchers found that 26 of the patients with CDIE (14.7 percent) died during the index hospitalization, including 18 of 141(12.8 percent) who underwent device removal and 8 of 34 (23.5 percent) who did not. Between hospital discharge and 1-year follow-up, 15 patients died and 10 were lost to follow-up. Overall, of the 177 patients with CDIE enrolled, 126 (71.2 percent) were alive at 1 year and 41 (23.2 percent) had died.
Coexisting valve infection was found in 66 patients (37.3 percent); other complications included heart failure (15.3 percent) and persistent bacteremia (15.8 percent). "Several of these complications were found to be associated with in-hospital and 1-year mortality in patients with CDIE. The high rates of mortality emphasize the need for improved preventive measures, including optimal skin decontamination and appropriate antibiotic administration at the time of cardiac device insertion or manipulation, as well as careful attention to any invasive or intravascular procedures performed after device implantation," the authors write.
Health care-associated infection was identified in 81 (45.8 percent) patients with CDIE, including 61 (34.5 percent) with nosocomial (hospital-acquired) and 20 (11.3 percent) with nonnosocomial infections.
Additional analysis showed a survival benefit at 1 year for device removal during the initial hospitalization (28/141 patients [19.9 percent] who underwent device removal during the index hospitalization had died at 1 year, vs. 13/34 [38.2 percent] who did not undergo device removal).
"Given that numbers of cardiovascular implantable electronic devices placed are increasing rapidly, further studies on the prevention and treatment of this serious complication are needed," the authors conclude.
More information: JAMA. 2012;307:1727-1735.
Provided by JAMA and Archives Journals
- Surgery improves endocarditis-induced heart failure survival rates Nov 22, 2011 | not rated yet | 0
- Older age associated with risk of complications, death after implantation of cardiac devices Apr 12, 2010 | not rated yet | 0
- Cardiovascular implantable electronic device-related infections linked with increased risk of death Sep 12, 2011 | not rated yet | 0
- Adults with aortic valve disorder do not experience reduction in survival rate Sep 16, 2008 | not rated yet | 0
- New study: Infections after cardiac device implantation produce excess costs and mortality Apr 04, 2011 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Calculating on-axis elements of a solenoid
6 hours ago I wanted to mention that this solenoid has many winds over many layers. The thickness of the windings is 2.4 inches coming off of the engineering...
latitude & longitude & air pressure
7 hours ago Hi there, I have a peculiar question. Imagine that you are in a earth position, obtained by google, that gives you the latitude and longitude....
Differences of Classical Mechanics when learned with Calc vs algebra?
10 hours ago what are the differences? Every example I find usually has a derivative or integral or some kind of calculus defined concept that seems to make it...
what is the distance traveled
14 hours ago A rough sketch of experiment. Image: http://i43.tinypic.com/14t4sk5.png the red dots represent a side view of path traveled, F is downward force...
Image of a Convex Lens Cut in Half Horizontally
18 hours ago Hello everyone, A friend of mine came up with this question in class and I really do not have a good answer. Suppose you have a convex lens...
Ray tracing through optical system of thick lenses
18 hours ago Can you advise me a free software that allow to draw rays passed throught system of thick lenses (preferable in 3D)?
- More from Physics Forums - Classical Physics
More news stories
Costs to treat stroke are projected to more than double and the number of people having strokes may increase 20 percent by 2030, according to the American Heart Association/American Stroke Association.
Cardiology 15 hours ago | not rated yet | 0
Blood thinners are the preferred treatment option to prevent heart attacks, blood clots and stroke, but they are not without risk, and not just because of their side effects. These high-risk drugs, known as anticoagulants, ...
Cardiology 18 hours ago | not rated yet | 0
Results from a large observational study reported at EuroPCR 2013 today question whether bivalirudin is superior to heparin in the absence of GPIIb/IIIa blockade, showing similar 30-day mortality in patients with non-ST segment ...
Cardiology 18 hours ago | not rated yet | 0
The DESolve bioresorbable coronary scaffold system achieves good efficacy and safety with low rates of late lumen loss and major coronary adverse events at six months, show first results from the pivotal DESolve Nx trial ...
Cardiology 18 hours ago | not rated yet | 0
The Orsiro stent, which is a novel stent platform eluting sirolimus from a biodegradable polymer, demonstrated non-inferiority to the Xience Prime everolimus-eluting stent for the primary angiographic endpoint of in-stent ...
Cardiology May 21, 2013 | 5 / 5 (1) | 0
Swiss scientists reveal the mechanism responsible for aging hidden deep within mitochondria—and dramatically slow it down in worms by administering antibiotics to the young.
14 hours ago | 4.9 / 5 (7) | 0 |
Existing research shows that bicyclists who wear helmets have an 88 percent lower risk of brain injury, but researchers at Boston Children's Hospital found that simply having bicycle helmet laws in place showed a 20 percent ...
3 hours ago | not rated yet | 0
Researchers from Queen Mary, University of London have led the largest sequencing study of human disease to date, investigating the genetic basis of six autoimmune diseases.
14 hours ago | 4.7 / 5 (3) | 0 |
Until now, little was scientifically known about the human potential to cultivate compassion—the emotional state of caring for people who are suffering in a way that motivates altruistic behavior.
11 hours ago | 5 / 5 (2) | 2 |
(HealthDay)—Migraines and depression can each cause a great deal of suffering, but new research indicates the combination of the two may be linked to something else entirely—a smaller brain.
11 hours ago | 4 / 5 (2) | 0 |
A new approach for immunizing against influenza elicited a more potent immune response and broader protection than the currently licensed seasonal influenza vaccines when tested in mice and ferrets. The vaccine ...
11 hours ago | not rated yet | 0 |