Background: Cardiovascular Implantable Electronic Device (CIED) therapy has become an effective strategy of care for patients with bradyarrhythmias and heart failure worldwide. CIED-related infections pose significant morbidity and mortality, and early recognition of it is paramount. The implementation of electronic medical record alert (EMA) systems for patients with sepsis has improved outcomes. However the impact of an EMA in patients with CIED is unknown.
Objective: To determine the impact of EMA in individuals with CIED-related infections in the process of care of these patients
Methods: This is a single-center, before-and-after observational study of adult patients with positive blood culture(s) and CIEDs that presented to the hospital before and after the EMA implementation to the electronic record, during an equidistant period of 3 years. The measured outcomes were time from the positive culture / alert to performance of clinical evaluation and respective workup. We present continuous variables as median (IQR) and categorical variables as percentages. Student t-test, Levene’s test and Chi-Square were performed for comparison
Results: A total of 148 EMAs were received and 8 patients (5.4%) underwent CIED removal. A total of 16 patients (8 in each group) were included for analysis. The majority (75%) were men, with median age 65 (61.7-75.2) and 70.5 (60.7-85.2) years before and after EMA respectively. CIED-related infection was predominantly infective endocarditis (31.3%), followed by bacteremia (18.3%) and pocket infection (12.5%), with Staphylococcus aureus bring the most common pathogen (43.8%). A trend towards improvement of time to echocardiogram performance (30.8 vs. 78.6 hours), time to infectious disease consultation (34.5 vs. 86.5 hours), time to cardiology consultation (34.8 vs. 117 hours) and time to device removal (137.3 vs. 186.8 hours) were observed, but did not reach statistical significance (p>0.05). Time to administration of antibiotics was similar pre and post EMA (6.3 vs. 5 hours)
Conclusion: In patients with CIED and positive blood culture(s), the presence of EMA shows trends to improve the time to evaluation and device removal; however, larger multi-center data is needed to improve statistical power.