An urgent call for quality measures for cardiac implantable electronic device infections in the United States

Infection is a significant cause of morbidity and mortality among patients with cardiac implantable electronic devices (CIEDs). Over 400,000 CIEDs are placed annually in the United States with an infection rate of approximately 1-2% in the first 12 months after implantation. In 2010, the American Heart Association provided a class I recommendation for complete system removal in all cases of endovascular CIED-I or pocket infection. Retrospective studies have shown that CIED removal is associated with improved outcomes, and prompt CIED removal within 7 days of confirmed infection is associated with lower mortality at 1-year compared to extraction after 7 days. Despite these strong recommendations and existing evidence, data demonstrates that ∼80% of patients with CIED-I do not undergo device extraction. To address this gap, we advocate for creation of an electronic clinical quality measure (eCQM) that would create incentives for hospitals to provide efficient, guideline-concordant care, analogous to existing eCQMs for other conditions, such as ST elevation myocardial infarctions. At present, patients with CIED-Is are dying unnecessarily due to non-adherence with evidence-based, guideline recommended care. Healthcare providers and professional societies, working alongside government agencies, have an opportunity to significantly improve outcomes by developing a sustainable, accountable care model for CIED-Is.