NHLBI-NIAID working group on antimicrobial strategies and cardiothoracic surgery
Increasing rates of cardiac device infections among medicare beneficiaries: 1990–1999

https://doi.org/10.1016/j.ahj.2003.06.005Get rights and content

Abstract

Background

Although cardiac devices have been found to reduce symptoms and mortality rates in appropriate patient populations, the implications of certain important risks, such as infection, are incompletely understood. The purpose of this study was to use a large population-based database to define the population that is at risk for cardiac device infections, determine the prevalence of device infections, and study changes in the rates of cardiac device implantation and infection in the past decade.

Methods

Patients with cardiac device implantations and infections were identified with claims files from the Health Care Finance Administration for Medicare beneficiaries from January 1, 1990, through December 31, 1999. Rates of implantation of cardiac devices were determined. Time trend analyses were performed to determine the significance of the observed change in rates.

Results

Cardiac device implantation rates increased from 3.26 implantations per 1000 beneficiaries in 1990 to 4.64 implantations per 1000 beneficiaries in 1999, which represents an increase of 42% in 10 years (P for trend <.001). Cardiac device infections showed a larger increase, from 0.94 device infections per 1000 beneficiaries in 1990 to 2.11 device infections per 1000 beneficiaries in 1999, which represents an increase of 124% during the study period (P for trend <.001).

Conclusions

During the previous decade, there was a significant increase in both cardiac device implantations and infections in elderly patients, although the increase in the rates of device infections was substantially higher. Additional studies are needed to better understand the relationship and timing between cardiac device implantation and infection.

Section snippets

Methods

We analyzed claims files from the Health Care Finance Administration for Medicare beneficiaries from January 1, 1990, through December 31, 1999, to identify patients receiving Medicare benefits who had device infections using the Medicare Provider Analysis and Review (MEDPAR) data files. International Classification of Disease, 9th edition (ICD-9) codes and Diagnostic Related Group (DRG) codes were used to identify patients with a cardiac device (prosthetic heart valves, 352.0–352.8; permanent

Patient sample characteristics

The basic characteristics of the patients undergoing cardiac device implantation are given in Table I.The number of patients with implantations was 22,152 in 1990, but rose substantially during the study period to 36,310 in 1999. In addition, the population undergoing these procedures also showed an increase in mean age during the study period (Table I). In all years, most patients were male and white.

Rates of prosthetic valve/cardiac device implantation and infection: 1990–1999

From 1990 to1999, cardiac device implantation rates increased by 42%, from 3.26 procedures per

Discussion

Implantation of a cardiac device can offer lifesaving therapy to patients with various cardiovascular diseases, but these procedures carry significant risks, including infection. In this study, population-based data were used to better understand the extent of the infection risk posed by an increasing use of these devices. This study addresses changes in both the size of the population at risk for device infections and the rates of device infections with 2 key observations.

First, the number of

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    Supported by grants K23 HL70861-01 (C.H.C.), AHA BGIA 0265405U (C.H.C.), K23 AI-01647 (V.G.F.), and a Career Development Award from the VA Health Services Research and Development Service (P.H.).

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