New research indicates that psoriasis is independently associated with a heightened risk of device-related infective endocarditis (IE) among individuals with permanent pacemakers (PPM). These findings, derived from a study utilizing data from the National Inpatient Sample database, highlight significant implications for clinical management in this patient population.
Led by Chapman Wei from Northwell Health’s Department of Medicine in New York, the study underscores the association between psoriasis and adverse cardiovascular outcomes, such as myocardial infarction and stroke. While previous studies have identified common comorbidities like dyslipidemia, hypertension, and atherosclerosis among psoriasis patients, the link to infective endocarditis had not been extensively explored until now.
The investigation enrolled individuals with a history of PPM implantation from the years 2016 to 2018, using the robust National Inpatient Sample database supported by the Healthcare Cost and Utilization Project. Baseline demographic data and comorbidities were extracted using International Classification of Diseases, 10th Revision (ICD-10) codes, with strict inclusion criteria excluding patients under 18 years old and those with certain medical histories.
Participants were categorized into two cohorts based on the presence or absence of psoriasis. The primary outcome measured was the incidence of infective endocarditis, with secondary outcomes including rates of skin and soft tissue infections. The analysis employed both univariate and multivariate methods, adjusting for gender, age, and baseline comorbidities to ensure statistical rigor.
The study’s findings revealed a notable association between psoriasis and increased rates of infective endocarditis among PPM patients. Specifically, individuals with psoriasis demonstrated a significantly higher incidence of infective endocarditis compared to those without (4.4% vs. 0.6%, P < .01). Multivariate analysis further confirmed this association, showing an odds ratio of 7.2 (95% CI: 1.7–30.2; P < .01). After propensity score matching, the risk remained markedly elevated with an adjusted odds ratio of 8.3 (95% CI: 2.0–34.4; P < .001).
In conclusion, the study suggests that psoriasis represents a substantial risk factor for infective endocarditis and skin/soft tissue infections in patients with PPM. The researchers recommend considering antibiotic prophylaxis for individuals with psoriasis undergoing PPM implantation to mitigate IE risk. They emphasize the necessity for further large-scale studies to validate these findings and refine guidelines for managing this vulnerable patient group.
This research contributes critical insights into the intersection of dermatological conditions and cardiovascular health, potentially shaping future clinical practices and guidelines for preventive care among pacemaker recipients with psoriasis.
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