Abstract 16204: Scaling Hearts: Exploring the Link Between Psoriasis and Infective Endocarditis in Pacemaker Patients

Abstract

Introduction: Device related infective endocarditis (IE) is associated with high morbidity and mortality resulting in a growing emphasis on identifying and managing comorbidities that increase the risk of IE in these patients. Psoriasis, a chronic inflammatory skin disorder with multifactorial etiology, is increasingly being identified as having multiple cardiovascular manifestations. However, little is known about the impact of psoriasis on IE risk in patients with permanent pacemaker (PPM). Hypothesis: Psoriasis patients with PPM have an increased risk of developing IE. Methods: Patients with a history of PPM implantation were sampled from the National Inpatient Sample Database (2016 - 2018). Comorbidities were identified using ICD-10 codes. Individuals with age < 18, history of endocarditis, immunosuppression, central line associated infections, intravenous drug use, and implantable cardiac defibrillators were excluded. Patients were stratified into two groups based on the presence of psoriasis. A univariate analysis followed by a multivariate analysis adjusting for age, gender valvular disease, dental infections, coronary artery disease, and sixteen other comorbidities was performed. Furthermore, 1:10000 propensity score matching was performed between the psoriasis and non-psoriasis groups and rates of IE were calculated. Results: Out of the 437,728 patients included in the study, 45 (4.4%) had psoriasis. Psoriasis patients were older and had more coronary artery disease. Psoriasis patients had significantly higher rates of endocarditis (4.4% vs 0.6%; p<0.001). On multivariate analysis, psoriasis was linked to a 7.2-fold higher IE risk compared to patients without psoriasis (OR: 7.2 [1.7-30.2]; p=0.007). Post-match analysis showed similar results with 8.3-fold higher rates of IE in psoriasis patients (OR: 8.3 [2.0-34.4]; p<0.001). Conclusions: Psoriasis was independently associated with elevated risk of IE in patients with PPM. The chronic inflammatory state associated with psoriasis likely contributed to this risk. Further large-scale studies are required to corroborate these findings as this will have implications on consideration of IE prophylaxis for these patients.