Abstract 11346: Overcoming Barriers to Complete and Early Extraction for CIED Infection: A Narrative Review of the Epidemiological, Clinical and Economic Evidence

Abstract

Background: As the number of patients with cardiac implantable electronic devices (CIEDs) grows, they are likely to present with issues to diverse groups of physicians. Clinical guidelines have Class I recommendations for complete CIED extraction for infection. Guideline-adherent management is associated with improved prognosis in patients with CIED infection. However, this is insufficiently implemented in practice and there is limited discussion on barriers and solutions to optimizing treatment. Purpose: The objective is to provide a comprehensive overview of CIED infections with respect to (1) current guidelines for treatment of CIED infection (2) awareness of those guidelines in clinical practice, and (3) overcoming barriers to the guideline adherence. Methods: This review assessed the current literature landscape from January 1, 2005 to October 21, 2020 on the burden of CIED infection, clinical outcomes for CIED extraction, and guideline recommendations pertaining to CIED extraction. Results: Fifty-seven publications were included for this review. Five clinical practice guidelines reported a Class I indication for complete device and lead removal in all patients with defined CIED infection (systemic, local, bacteremia, or infection endocarditis). CIED infection rates ranged between 0.8% to 4.2% globally and such infections were found to be associated with substantial clinical and economic burden. Clinical studies assessing CIED extraction for infection consistently reported high procedural success (~95%), low major procedural complication rates (0% to 4.8%) and very low procedural mortality rates (0% to 2.4%). Furthermore, several studies reported that complete and early extraction has significant clinical and economic benefit compared with no extraction or late extraction. However, a large physician survey reported poor compliance with recommendations globally. Conclusions: The research indicates that barriers to optimal treatment may include challenges with infection diagnosis and patient referral to extraction centers, as well as misconceptions regarding extraction procedures. To help address these barriers, a multiprong quality initiative to optimize patient care pathways and increase awareness is necessary.