PO-632-04 PATTERNS OF DEVICE-RELATED INFECTION IN DE NOVO TRANSVENOUS IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR MEDICARE PATIENTS WITH UNDERLYING RENAL DISEASE

Abstract

Renal disease is a risk factor for device infection in transvenous implantable cardioverter-defibrillator (TV-ICD) implants. Since chronic dialysis treatment for advanced renal disease creates a portal of entry for bacteria that can seed indwelling devices, we hypothesized that infection risk could accelerate after TV-ICD implantation in renal patients, especially dialysis dependent (DD) patients. Medicare 100% administrative and claims data were used to identify patients who underwent de novo TV-ICD implantation (7/2016-12/2018). Patients were followed up to 540 days post implantation. Baseline characteristics, including renal disease (none; renal-non-DD; and renal-DD), and device infection during follow-up were identified using claims diagnosis and procedure codes. Statistical analysis consisted of Poisson regression with restricted cubic splines, followed by plotting predicted hazard ratios (HR) for TV-ICD infection in renal-non-DD and renal-DD patients to identify changes in infection risk over time. 42,200 TV-ICD patients were included (9,151 [22%] renal-non-DD; 1,832 [4%] renal-DD), with 809 (2%) device infections. The HRs for infection (Figure) increased with time in both renal disease groups: 2.5-fold in renal-non-DD patients over 18 months; and almost 10-fold in renal-DD patients before leveling off after approximately 12 months. The risk of infection following TV-ICD implantation is significantly higher in patients with underlying renal disease and increases over time, particularly in patients who are dialysis dependent.