1202-A - Cardiac Devices: Underrecognized Source of Hospital-associated Infections

Session Description : More than half a million people are implanted with cardiac implantable electronic devices (pacemakers, defibrillators, cardiac resynchronization therapy-defibrillators) annually. These devices are lifesaving and have significantly improved the quality of life and outcomes of millions of patients worldwide. Although these devices are generally safe and well tolerated, life-threatening complications like device infections occur. Infections are common in clinical practice. Rates of device infections range from 0.5% to 1% for initial implants and 1% to 5% for device replacements or upgrades.

Prompt exaction of the device and all associated device leads is the guideline-directed treatment of choice for cardiac device infections. Unfortunately, new data shows that 1 in 5 patients do not receive guideline-directed treatment and suffer undue morbidity and mortality. 1 in 3 patients who do not receive total device extractions within 30 days die within one year. Early extraction confers better outcomes—in a dose-response fashion, earlier extraction was associated with a 41% lower hazard of mortality, significantly lower compared with later extraction. Reviews of Medicare data have suggested that the US annual medical costs were 2.4x greater for device infection patients compared with no infection.

Quality improvement initiatives and care redesign programs are needed to improve the guideline-based care patients with cardiac devices receive within health systems. Infection prevention professionals are crucial to leading this charge. This session is intended to inform professionals about this dangerously overlooked source of infections and provide a framework to define gaps in care, identify barriers to guideline-directed care, and develop and implement multifaceted interventions to address the barriers to optimal care.