Abstract 9520: Referral From a Regional Facility is Associated With Higher One Year Mortality in Patients With Infected Cardiovascular Implantable Electronic Devices

Abstract

Introduction: The use of Cardiac Implantable Electronic Devices (CIEDs) has increased considerably over the past few decades driven by evolving device technology and expanding indications. CIED infections are an important consideration given their clinical and economic impact. Hypothesis: This study sought to assess the impact of regional referral versus direct presentation to expert tertiary care facility in patients with infected CIED. Methods: Retrospective analysis of a regional database of patients presenting with CIED infection to medical centers across Western New York, USA from 2012 - 2020. We compared the 1-year mortality among the patients presenting directly to expert tertiary care facilities versus those referred from regional facilities. Results: A total of 296 patients (74% male, age 69.2 ± 13.7) were included in the study of which 290 (98%) underwent CIED extraction (Table 1). Of the 296 patients, 99 (33.4%) presented from regional centers and 197 (66.5%) presented directly to expert centers. 24 (24.2%) patients referred from regional centers died within one year as compared to 28 (14.2%) patients presenting to expert tertiary care facilities (p=0.02) (Figure 1). Conclusions: In patients with CIED infections, referral from a regional facility is associated with worse outcomes. This may relate to the delay in definite management and underscores the importance of early identification and the need for a robust referral infrastructure to improve patient outcomes.