DENVER – Whether cardiac electronic devices are implanted in an inpatient or outpatient setting doesn’t affect device infection rates, according to a national analysis of Medicare data for 1997-2010.
Outpatient implantations are on the upswing. From 1997 to 2010, the proportion of pacemaker implantations performed in Medicare patients on an outpatient basis climbed from 8.6% to 29%. In addition, the proportion of pacemaker revision procedures done in outpatient settings nearly doubled, from 37% to 72%, Dr. Arnold J. Greenspon reported at the annual meeting of the Heart Rhythm Society.
Dr. Arnold Greenspon
Similarly, outpatient installation of implantable cardioverter defibrillators (ICDs) accounted for just 6.2% of all ICD implantations in 1997, but 36% in 2010. The proportion of ICD revision procedures performed on an outpatient basis rose from 31% to 69% during this time period, added Dr. Greenspon, professor of medicine and director of the cardiac electrophysiology laboratory at Thomas Jefferson University, Philadelphia.
Device infection rates following primary implantation have been waning. The ICD infection rate dropped from 1.3% in 1997 to 0.8% in 2010. Pacemaker infections are less frequent: The rate was 0.9% in 1997, falling to just 0.2% in 2010.
However, the risk of deep infection warranting inpatient revision surgery has increased over time. The annual number of patients undergoing inpatient device removal on the basis of ICD diagnosis codes for deep infection or sepsis increased two- to -threefold during 1997-2010.
Risk factors for infection identified in this study included advanced age, renal failure and other medical comorbidities, and an increasing number of cardiac device procedures. Indeed, the pacemaker and ICD infection rates climbed to 14% and 9%, respectively, in patients who had undergone five device procedures.
This study was funded by Medtronic. Dr. Greenspon reported serving as a consultant to Medtronic, Boston Scientific, and St. Jude Medical.