🎧 Two studies of cardiac device infections, observational studies, RCTs, and our ways of knowing in Medicine are the topics discussed by drjohnm in this week's podcast. CardioTwitter
that then attaches to leads. Infection on leads can then affect cardiac valves, and cause endocarditis.Once this process happens, we have a super-serious problem because pacing or ICD leads that have been implanted for years cannot easily be pulled out. The body reacts to foreign material by forming scar around the leads. This causes the lead to attach to the superior vena cava, atria, tricuspid valve, or right ventricle.
Finding one: The cumulative incidence of infection was 0.6%, 0.7%, and 0.9% within 3, 6, and 12 months, respectively. But the absolute rate of Infection was highest in the first 3 months , reducing significantly thereafter. Finding three: Early localized infection caused no increase in mortality, however, early systemic infection caused a big, 3-fold increase in mortality.
They write that early detection and treatment of CIED infections may be important. They wonder about the common policy of checking the incision at one week and then not seeing patients again until 12 months. The NRD is a database of de-identified hospital inpatient discharges and readmissions that allows for national estimates of hospital utilization. I will not object to parts of this study, but regarding others I will have strong objections.
The problem comes in the temptation to compare patients who had vs did not have TLE. Of course, these are non-random comparisons in which a clinician made a decision to extract or not.
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