Infection risks of cardiac implants in germany: new study reveals incidence and mortality rates

Abstract Background The global rise in infections associated with cardiovascular implantable electronic devices (CIEDs) is a matter of increasing concern. However, comprehensive and detailed data on the incidence and consequences of these infections within the German-speaking population remain limited. This study aims to provide an extensive analysis of the incidence of acute CIED-related procedures, hospital admissions due to CIED infections, and the associated mortality rates in Germany. Methods For this investigation, we analysed the billing data from Germany’s largest health insurance provider, AOK, focusing on the number of CIED-related procedures and associated infections in 2019. To identify cases of CIED infections, we utilised specific procedural codes (OPS) and the International Classification of Diseases, 10th Revision, German Modification (ICD-10-GM). In a second step, infections were categorised as either local CIED pocket infections or CIED-related endocarditis. The patients’ discharge status was also documented. Results In 2019, among the 27 million AOK members, a total of 51,992 patients (of whom 58.0% were male) underwent one or more CIED-related procedures. Of these, 1,051 patients (2.02%) required hospitalisation due to localised CIED infections or the development of such infections within three months post-procedure. The occurrence of these infections was associated with an increased mortality rate of 8.7%. Additionally, 508 patients (0.97%) were hospitalised due to CIED-associated endocarditis, resulting in an elevated mortality rate of 14.0%. Patients with CIED pocket infections and CIED-related endocarditis were, on average, younger (median age 70.2 and 66.8 years, respectively, compared to 74.0 years in patients without infections) and more frequently male (69.5% and 71.3%, respectively, compared to 58.0%). On average, patients with CIED infections required 2.74 additional procedures, whereas patients with endocarditis required an average of 2.37 additional procedures. Conclusion This study indicates an elevated prevalence of acute CIED infections compared to previous reports. The requirement for multiple additional interventions may suggest insufficient adherence to treatment guidelines for CIED infections, potentially impacting patient outcomes negatively. These findings underscore the importance of improved compliance with infection prevention protocols to mitigate the burden of such infections.Flow Chart