Oluwadamisola Temilade Sotade

Objectives: To quantify the rate of cardiac implantable electronic device (CIED)‐related infections and to identify risk factors for such infections. Design: Retrospective cohort study; analysis of linked hospital admissions and mortality data. Setting, participants: All adults who underwent CIED procedures in New South Wales between 1 January 2016 and 30 June 2021 (public hospitals) or 30 June 2020 (private hospitals). Main outcome measures: Proportions of patients hospitalised with CIED‐related infections (identified by hospital record diagnosis codes); risk of CIED‐related infection by patient, device, and procedural factors. Results: Of 37 675 CIED procedures (23 194 men, 63.5%), 500 were followed by CIED‐related infections (median follow‐up, 24.9 months; interquartile range, 11.2–40.8 months), including 397 people (1.1%) within twelve months of their procedures, and 186 of 10 540 people (2.5%) at high risk of such infections (replacement or upgrade procedures; new cardiac resynchronisation therapy with defibrillator, CRT‐D). The overall infection rate was 0.50 (95% confidence interval [CI], 0.45–0.54) per 1000 person‐months; it was highest during the first month after the procedure (5.60 [95% CI, 4.89–6.42] per 1000 person‐months). The risk of CIED‐related infection was greater for people under 65 years of age than for those aged 65–74 years (adjusted hazard ratio [aHR], 1.71; 95% CI, 1.32–2.23), for people with CRT‐D devices than for those with permanent pacemakers (aHR, 1.46; 95% CI, 1.02–2.08), for people who had previously undergone CIED procedures (two or more v none: aHR, 1.51; 95% CI, 1.02–2.25) or had CIED‐related infections (aHR, 11.4; 95% CI, 8.34–15.7), or had undergone concomitant cardiac surgery (aHR, 1.62; 95% CI, 1.10–2.39), and for people with atrial fibrillation (aHR, 1.33; 95% CI, 1.11–1.60), chronic kidney disease (aHR, 1.54; 95% CI, 1.27–1.87), chronic obstructive pulmonary disease (aHR, 1.37; 95% CI, 1.10–1.69), or cardiomyopathy (aHR 1.60; 95% CI, 1.25–2.05). Conclusions: Knowledge of risk factors for CIED‐related infections can help clinicians discuss them with their patients, identify people at particular risk, and inform decisions about device type, upgrades and replacements, and prophylactic interventions.

Aims: An infection following cardiac implantable electronic device (CIED) procedure is a serious complication, but its association with all-cause mortality is inconsistent across observational studies. To quantify the association between CIED infection and all-cause mortality in a large, contemporary cohort from New South Wales, Australia. Methods and results: This retrospective cohort study used linked hospital and mortality data and included all patients aged >18 years who underwent a CIED procedure between July 2017 and September 2022. Cardiac implantable electronic device infection was defined by the presence of relevant diagnosis codes. Cox regression to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) for the association of CIED infection with mortality, at 1-year, and at the end of follow-up, with CIED infection included as a time-dependent variable, and other potential risk factors for mortality included as fixed covariates. We followed 37,750 patients with CIED procedures {36% female, mean age [standard deviation (SD)] 75.8 [12.7] years}, and 487 (1.3%) CIED infections were identified. We observed 5771 (15.3%) deaths during an average follow-up of 25.2 (SD 16.8) months. Compared with no infection group, patients with CIED infection had a higher Kaplan-Meier mortality rate (19.4 vs. 6.8%) and adjusted hazard of mortality (aHR 2.73, 95% CI 2.10−3.54) at 12 months post-procedure. These differences were attenuated but still remained significant at the end of follow-up (aHR 1.83, 95% CI 1.52−2.19). Conclusion: In a complete, state–wide cohort of CIED patients, infection was associated with higher risks of both short–term and long–term mortality.

Objectives To quantify age-stratified outcomes of bioprosthetic valve (BV) and mechanical valve (MV) surgical aortic valve replacement (AVR) in Australian patients. Design Retrospective cohort study using population-based linked hospital morbidity and mortality data. Setting Public and private hospitals. Participants Patients aged 18 years and over undergoing AVR from 2001 to 2013, stratified by age (18–64 years; 65+ years). Main outcome measures Age-standardized index AVR rates; rates and multivariable-adjusted (age, sex, Charlson Comorbidity Index) incidence rate ratios (IRRs) for reoperation, incident cardiovascular events (hospitalization or death for acute myocardial infarction (AMI), stroke, major hemorrhage or thromboembolism) and mortality (cardiovascular and all-cause). Results Our cohort comprised 13 377 patients, of whom 3464 (26%) were aged 18–64 years. Annual age-standardized AVR rates increased by 2.7% with BV implants increasing in both age groups. After 5 years of follow-up, patients implanted with BV had lower rates of stroke (IRR: 0.40, 95% CI 0.27 to 0.60) and hemorrhage (IRR: 0.36, 95% CI 0.26 to 0.50). Among patients 65+ years, those implanted with BV had lower rates of AMI, hemorrhage, and cardiovascular and all-cause mortality than those implanted with MV (IRR: 0.71, 95% CI 0.53 to 0.96; IRR: 0.77, 95% CI 0.62 to 0.95; IRR: 0.80, 95% CI 0.69 to 0.92 and IRR: 0.85, 95% CI 0.74 to 0.97, respectively). After 6–10 years of follow-up, reoperation rates among patients 18–64 years were markedly higher in those implanted with BV compared with MV (IRR: 5.48, 95% CI 2.38 to 12.62) and rates of AMI were lower among patients implanted with BV compared with MV (IRR: 0.49, 95% CI 0.26 to 0.94). Among patients 65+ years rates of cardiovascular and all-cause mortality remained significantly lower for patients implanted with BV compared with MV. Conclusions This study provides real-world evidence of AVR use and outcomes. Use of BV implants is increasing irrespective of age. Valve choice in younger patients requires thorough evaluation of patient factors influencing both short-term outcomes and longer-term risks of reoperation, stroke and hemorrhage.

Introduction and Aims: Cannabis use rates in Australia have declined since 2001. No research to date has examined possible reasons, despite evident policy interest in understanding such a positive public health outcome. In a ‘first pass’ examination, five possible reasons are explored: (i) attitudinal shifts regarding the acceptability of cannabis use; (ii) regulatory or policy changes; (iii) supply/market changes; (iv) changes in other drug use that may operate as substitutes or complements to cannabis; and (v) socio‐cultural factors.Methods: Secondary analyses from three publically available national surveys (the National Drug Strategy Household Survey 2001 to 2013, the Illicit Drug Reporting System 2004 to 2013 and the Illicit Drug Data Report 2002 to 2013) were used to explore the five reasons.Results: It appears that all five explanations are reasonable and have preliminary evidence to indicate they are worth pursuing empirically. Attitudes have not softened towards cannabis in Australia, and regulatory changes appear to have tightened. Perceived purity may have declined, and with stable prices, this suggests an increase in purity‐adjusted price that would also be consistent with decreased use. The significant declines in tobacco and alcohol use in Australia, which operate as complements to cannabis, also plausibly account for the significant decrease.Discussion and Conclusions: This work suggests future directions for cannabis research in Australia. New multi‐disciplinary research that has the potential to explore multiple hypotheses simultaneously is required. [Ritter A, Sotade O. Explaining the declining rates of past year cannabis use in Australia: A first pass. Drug Alcohol Rev 2017;00:000‐000]