Details

Autor(en) / Beteiligte

• Wilkoff, Bruce L
• Boriani, Giuseppe
• Mittal, Suneet
• Poole, Jeanne E
• Kennergren, Charles
• Corey, G Ralph
• Love, John C
• Augostini, Ralph
• Faerestrand, Svein
• Wiggins, Sherman S
• Healey, Jeff S
• Holbrook, Reece
• Lande, Jeff D
• Willey, Sarah A
• Tarakji, Khaldoun G

Titel

Abstract 13058: Impact of Cied Infection: A Clinical and Economic Analysis of the Wrap-It Study

Ist Teil von

• Circulation (New York, N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A13058-A13058

Ort / Verlag

by the American College of Cardiology Foundation and the American Heart Association, Inc

Erscheinungsjahr

2019

Quelle

EZB Electronic Journals Library

Beschreibungen/Notizen

• IntroductionCurrent understanding of the clinical and economic impact of CIED infection is based on retrospective analyses from medical records or administrative claims data. The WRAP-IT study offers a prospectively designed opportunity to evaluate the impact of CIED infection on mortality, quality of life (QOL), and health care utilization (HCU) in the US healthcare system.MethodsThis was a pre-specified, as-treated analysis which evaluated clinical outcomes related to CIED infectionsmortality, QOL, interruption in CIED therapy (n=70) and HCU (infection in US pts resolved prior to study exit, n=38). QOL was evaluated with EuroQOL-5D (EQ-5D) utilities at implant, infection diagnosis, and 1, 3, 6-months after diagnosis. Primary diagnosis codes, procedure codes and diagnosis related group assignments were imputed from study data. Payer costs were assigned using Medicare national payments, while hospital and patient costs were derived from similar hospital admissions in a separate administrative dataset. All currency reflects 2017 US dollars.ResultsMajor CIED infection was associated with increased all-cause mortality (12-month risk-adjusted HR 3.13, p<0.001). EQ-5D utilities were significantly reduced at time of infection diagnosis versus baseline (adjusted mean difference 0.09, p=0.004) and did not normalize until 6 months post-diagnosis. Infections with extraction and reimplantation in the same hospitalization (26/70) had interruption of CIED therapy for a median of 6.5 (range 0-22) days, for all other infections there was interruption for a median of 27.5 (range 0-749) days. Infections resulted in a mean of 3.9±5.9 clinic visits and 1.6±0.8 hospital admissions with a mean of 12.5±9.2 hospitalized days. Mean costs of infection treatment were $56,025±$46,688 for the hospital, $28,229±$15,066 for Medicare (mean hospital margin for Medicare patients -$30,051±$40,370). Mean out of pocket cost of a single infection-related hospitalization was $879±$263 for the patient.ConclusionsThis large, prospective analysis corroborates and extends understanding of the impact of CIED infections as seen in real world datasets. CIED infections result in severe impact to mortality, QOL, hospitalization and cost in the US healthcare system.