Outcomes of Patients Hospitalized With Cardiovascular Implantable Electronic Device–Related Infective Endocarditis, Prosthetic Valve Endocarditis, and Native Valve Endocarditis: A Nationwide Study, 2003 to 2017

Abstract

Background Most published reports describing outcomes of patients with cardiovascular implantable electronic device–related infective endocarditis (CIED‐IE) are single‐center studies with small patient sample sizes. The goal of this study was to utilize population‐based data to assess trends in CIED‐IE hospitalization and to compare outcomes between patients hospitalized with CIED‐IE, prosthetic valve endocarditis (PVE), and native valve endocarditis (NVE). Methods and Results A query of the National (Nationwide) Inpatient Sample (NIS) database between 2003 and 2017 identified 646 325 patients hospitalized with infective endocarditis in the United States of whom 585 974 (90%) had NVE, 27 257 (4.2%) had CIED‐IE, and 26 111 (4%) had PVE. There was a 509% increase in CIED‐IE hospitalizations in the United States from 2003 to 2017 ( P trend<0.001). In‐hospital mortality and length of stay associated with CIED‐IE decreased during the study period from 15% and 20 days in 2003 to 9.7% and 19 days in 2017 ( P trend=0.032 and 0.018, respectively). The in‐hospital mortality rate was lower in patients hospitalized with CIED‐IE (9.2%) than in patients with PVE (12%) and NVE (12%). Length of stay was longest in the CIED‐IE group (17 compared with 14 days for both NVE and PVE). Hospital costs were highest for the CIED‐IE group ($56 000 compared with $37 000 in NVE and $45 000 in PVE). Conclusions Despite the fact that the number of comorbidities per patient with CIED‐IE increased during the study period, mortality rate and hospital length of stay decreased. The mortality rate was significantly lower for patients with CIED‐IE than for patients with NVE and PVE. Patients with CIED‐IE had the longest lengths of stay and highest hospital costs.