A european survey of CIED infection management: identifying physician aptitude and assessing their evolution of knowledge over three years

Background Although prompt removal of cardiac implantable electronic devices (CIEDs) is a proven and effective treatment for infections, many patients with device-related infections do not receive care aligned with established guidelines [1,2]. Purpose To survey non-extracting physicians in Europe involved in CIED patient care on their baseline knowledge and management of patients with CIED infections, track changes in their understanding over the course of the survey term, and assess the impact of educational initiatives between survey intervals. Methods A double-blinded online survey was conducted in two intervals (2022 and 2024), targeting non-lead extracting European physicians from general cardiology (GC) and electrophysiology (EP) specialties who manage patients with CIED infections. Participants responded to eight multiple choice questions and two clinical vignettes designed to assess their awareness of CIED infections, management practices of patients with CIED infection, societal guideline knowledge, and treatment strategies. Results A total of 480 physicians from four European countries (Germany, UK, Italy, and France) completed the survey. Overall, 55% strongly agreed that systemic CIED infections necessitate complete system removal with a 20% improvement over survey intervals driven primarily by the EP responses; however, only 29% strongly agreed that the same applies to pocket infections. Most physicians were correctly able to identify four out of five Class I indications for the management of patients with CIED infection, and EPs were more familiar overall with Class I guidelines compared to GCs, with improvements in correct answers over the survey intervals ranging from 4-17%. In a clinical scenario involving a patient with a systemic CIED infection, 88% of respondents indicated guideline adherence with a 5% improvement over the survey intervals; however, in a similar scenario framed differently, only 25% adhered to guidelines. For a clinical scenario involving a CIED pocket infection, guideline adherence was observed in only 31% of responses with an overall improvement over survey terms, but not statistically significant. Conclusion In Europe, physician knowledge of guideline directed care of CIED infection management is moderately improving. Nevertheless, there are significant gaps in knowledge which should be addressed through targeted quality improvement initiatives.