Agarwal Siddharth, Asad Zain Ul Abideen, Munir Muhammad Bilal, Lee Justin Z, DeSimone Daniel C, DeSimone Christopher V, Deshmukh Abhishek J
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
J Cardiovasc Electrophysiol. 2025 May;36(5):1068-1072. doi: 10.1111/jce.16637. Epub 2025 Mar 11.
Cardiac implantable electronic device (CIED) infections are a serious complication associated with significant morbidity, mortality, and healthcare costs. Despite guideline recommendations for complete device removal, disparities in healthcare access and resource availability between urban and rural settings may influence patient outcomes. This study aims to evaluate rural-urban disparities in the management and outcomes of patients hospitalized with CIED infections.
A retrospective cohort analysis was conducted using the National Readmissions Database (NRD) from 2016 to 2021. Patients aged ≥ 18 years hospitalized with CIED infections were identified using ICD-10 codes. Hospital location was categorized as urban or rural based on the Urban Influence Codes. Baseline characteristics, complications, and outcomes were compared using chi-square and t-tests, and a multivariable logistic regression model was employed to assess the independent association of hospital settings with transvenous lead removal (TLR) utilization.
A total of 288,402 patients were hospitalized for CIED infections, with 94.9% treated in urban hospitals and 5.1% in rural hospitals. Urban hospital patients had a higher prevalence of key comorbidities, including heart failure, valvular heart disease, atrial fibrillation and peripheral vascular disorders. In-hospital mortality was significantly higher in urban hospitals (6.2% vs. 4.8%, p < 0.01) likely due to higher burden of comorbidities and higher rates of acute complications such as stroke (3.1% vs. 1.8%, p < 0.01) and systemic embolism (1.4% vs. 0.7%, p < 0.01). TLR was more frequently performed in urban hospitals (20.1% vs. 9.6%, p < 0.01), with rural hospitals exhibiting 59% lower odds of receiving TLR (OR: 0.41, 95% CI: 0.36-0.47, p < 0.01). TLR was associated with reduced in-hospital mortality, 30-day mortality, and 30-day readmission rates across both hospital settings.
Our study highlights significant rural-urban disparities in CIED infection management. Despite rural hospitals admitting patients with a lower comorbidity burden, TLR utilization was significantly lower, potentially due to limited access to specialized expertise and procedural resources. Given TLR's association with improved survival and reduced readmissions, regardless of the hospital setting, targeted interventions are needed to enhance access to specialized care in rural settings. Further research is warranted to explore strategies for bridging these disparities and optimizing CIED infection outcomes nationwide.
心脏植入式电子设备（CIED）感染是一种严重的并发症，会导致较高的发病率、死亡率和医疗成本。尽管指南建议完全移除设备，但城乡之间在医疗服务可及性和资源可用性方面的差异可能会影响患者的治疗结果。本研究旨在评估因CIED感染住院患者在管理和治疗结果方面的城乡差异。
使用2016年至2021年的国家再入院数据库（NRD）进行回顾性队列分析。使用ICD-10编码识别年龄≥18岁因CIED感染住院的患者。根据城市影响代码将医院位置分为城市或农村。使用卡方检验和t检验比较基线特征、并发症和治疗结果，并采用多变量逻辑回归模型评估医院环境与经静脉导线移除（TLR）使用的独立关联。
共有288,402例患者因CIED感染住院，其中94.9%在城市医院接受治疗，5.1%在农村医院接受治疗。城市医院患者的主要合并症患病率较高，包括心力衰竭、瓣膜性心脏病、心房颤动和周围血管疾病。城市医院的院内死亡率显著更高（6.2%对4.8%，p<0.01），可能是由于合并症负担较重以及中风（3.1%对1.8%，p<0.01）和系统性栓塞（1.4%对0.7%，p<0.01）等急性并发症发生率较高。TLR在城市医院更常进行（20.1%对9.6%，p<0.01），农村医院接受TLR的几率低59%（OR：0.41，95%CI：0.36-0.47，p<0.01）。在两种医院环境中，TLR均与降低院内死亡率、30天死亡率和30天再入院率相关。
我们的研究突出了CIED感染管理方面显著的城乡差异。尽管农村医院收治的患者合并症负担较低，但TLR的使用率显著较低，这可能是由于获得专业知识和手术资源的机会有限。鉴于TLR与提高生存率和降低再入院率相关，无论医院环境如何，都需要有针对性的干预措施来增加农村地区获得专科护理的机会。有必要进一步研究探索弥合这些差异并在全国范围内优化CIED感染治疗结果的策略。
