Heart Rhythm. 2026 Aug 18:S1547-5271(26)02687-1. doi: 10.1016/j.hrthm.2026.08.015. Online ahead of print.
ABSTRACT
BACKGROUND: Cardiovascular implantable electronic device (CIED) infections are characterized by substantial morbidity, mortality, and economic burden. Contemporary national data analysis stratifying CIED infections by reimplantation strategy is limited.
OBJECTIVES: To characterize incidence, patient and hospital predictors, microbiology, in-hospital mortality, and costs of CIED infections requiring device removal stratified by same-admission reimplantation versus those without same-admission reimplantation.
METHODS: Using the National Inpatient Sample, adult U.S. hospitalizations (2016-2022) with CIED-related infection requiring device removal were identified with ICD-10-CM/PCS codes. Hospitalizations were classified as CIED infection with same-admission reimplantation or CIED infection without same-admission reimplantation. Survey-weighted analyses estimated national incidence, temporal trends, and inflation-adjusted hospitalization costs. Multivariable survey-logistic regression identified predictors of infection and in-hospital mortality and evaluated organism-specific mortality among cases with coded pathogens.
RESULTS: Among approximately 1.2 million CIED implantation hospitalizations, 58,880 involved CIED infection requiring device removal (annual rate 0.024%; p for trend = 0.237). Same-admission reimplantation accounted for 31.2% of infections and declined over time, while hospitalizations without same-admission reimplantation increased to 71.4% (both p for trend = 0.0006). Congestive heart failure, atrial fibrillation, autoimmune disease, malnutrition, obesity, and peripheral arterial disease were independently associated with infection, whereas female sex was protective. Staphylococcal species were coded in 38.8% of infections; methicillin-resistant Staphylococcus aureus (MRSA) nearly doubled in-hospital mortality, whereas methicillin-susceptible S. aureus (MSSA) was not independently associated with excess adjusted mortality. Adjusted in-hospital mortality for CIED infection hospitalizations increased from 4.6% to 6.0%, and inflation-adjusted mean costs for infection admissions had increased by 28.5%.
CONCLUSION: In this contemporary, nationally representative ICD-10 era cohort, the CIED infection rate requiring extraction remained low and stable at 0.024%, yet these events carried outsized clinical and economic consequences. Nearly 70% of infections were managed without same-admission reimplantation and occurred predominantly in patients with substantial multimorbidity, delineating a large, previously underrecognized population. MRSA infections nearly doubled in-hospital mortality, whereas MSSA, despite being more prevalent, was not independently associated with excess adjusted mortality. Infection-related hospitalization costs increased by almost 30% and rose 1.6-fold faster than costs for uncomplicated CIED implantations, indicating that CIED infections consume a disproportionate and accelerating share of healthcare resources.
PMID:42612892 | DOI:10.1016/j.hrthm.2026.08.015