Cardiovascular Implantable Electronic Devices -> Tachycardia Devices: -> Clinical Trials D-PO06 - Poster Session VI (ID 26) Poster

D-PO06-026 - PADIT CIED Infection Risk Score Profile In High Volume Implant Centers: Implications For Procedure And Health Care Resource Planning (ID 648)

Abstract

Background: Preoperative antibiotics are the sole guideline recommended therapy for prevention of cardiac implantable electronic device (CIED) infection. Incremental therapies are either minimally effective or costly. The PADIT risk score is a simple 5 component risk predictor using clinically available patient, procedure and device parameters (Previous procedures, Age, Decreased renal function, Immunosuppressed and Type of device, scale 0-15 points). Risk prediction with the PADIT risk score may be informative for patients and providers, assist in procedure planning and health economic analysis.
Objective: To determine the proportion of patients with low, intermediate and high-risk characteristics in large volume CIED implant centers.
Methods: The PADIT risk score was calculated in 11,303 patients from 6 large academic centers that enrolled all CIED patients. The proportion of patients at low, intermediate and high risk was determined (PADIT score ≤4, 5-6 and ≥7), with a separate analysis of low complexity patients (new pacemaker and ICD implant, not including CRT). An online PADIT risk score calculator is available (https://www.padit-calculator.ca/).
Results: Among 11,303 patients, 8918 were low risk (78.9% score ≤4, infection risk 0.53%), 1760 were intermediate risk (15.6% score 5-6, infection risk 1.36%), and 625 were high risk (5.5% score ≥7, infection risk 2.72%). In contrast, the 6686 low complexity patients had very few high-risk patients with a score ≥7 (n=12, 0.2%) with only 1 of the 34 infections in this group. Intermediate risk was noted in only 81 of 6686 new pacemaker or ICD patients (1.2%). There was no interaction between risk score and efficacy of incremental antibiotics in either the entire cohort or in the low complexity group.
Conclusion: High risk patients are a small minority of overall CIED patients, even in high volume implant centers where complex procedures are concentrated. De novo pacemaker and ICD procedures are largely associated with low-intermediate risk patients. The PADIT risk score can inform risk estimates for shared decision making and incremental interventions, and influence health care resource planning.
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