Continued Rise in Rates of Cardiovascular Implantable Electronic Device Infections in the United States: Temporal Trends and Causative Insights

Methods: We analyzed the occurrence of CIED infections and the associated changes in characteristics of CIED recipients, using the National Hospital Discharge Survey database from 1996 through 2006. Results: The number of CIED implantations continued to increase after 2003 from 199,516 in 2004 to 222,940 in 2006, representing a 12% increment. In the same period, the number of CIED infections increased from 8,273 in 2004 to 12,979 in 2006, representing a 57% increment. From 1996 to 2006, comorbid illnesses in recipients of new CIED devices became more prevalent with an increasing percentage of patients with end-organ failures (6.5% in 1996 vs 8.0% in 2006, P < 0.001) and diabetes mellitus (14.5% in 1996 vs 16.5% in 2006, P = 0.005). The proportion of Caucasian recipients also decreased (65.6% in 1996 vs 57.6% in 2006, P < 0.001). During that same period, the number of implanted cardiac resynchronization devices increased dramatically while the age of CIED recipients did not change. Conclusion: The number of patients with CIED-related infections in the United States continues to increase out of proportion to the increase in implantation rates. Possible causes for this on-going epidemic include sicker patients with varying racial backgrounds, and more complex procedures. These insights may help improve our ability to best select patients for CIED implantation in "real-life" settings. (PACE 2010; 414-419).