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. 2024 Nov 19;16(11):e74012.
doi: 10.7759/cureus.74012. eCollection 2024 Nov.

Retrospective Review Identifying Patients With Bacteremia and Intracardiac Devices With an Electronic Health Record Advisory

Gabriel Velez Oquendo  1 , Riaz Mahmood  1 , Joon Ahn  2 , Shane Robinson  3
Affiliations

Retrospective Review Identifying Patients With Bacteremia and Intracardiac Devices With an Electronic Health Record Advisory

Gabriel Velez Oquendo et al. Cureus. .

Abstract

Background: Cardiovascular implantable electronic device (CIED) infections without early diagnosis, treatment, and proper follow-up are associated with increased morbidity, mortality, and worse outcomes. Objective: This study aims to identify patients presenting for hospital admission with bacteremia and the presence of CIED by implementing a best practice advisory (BPA) notification in the electronic medical record to facilitate early consultation with the cardiac electrophysiology (EP) team and treatment.

Methods: A BPA was implemented into the electronic medical record (EMR) EPIC in 2022 and was generated for any patient that presented to our health system with bacteremia and the presence of a CIED. The BPA gave the provider an option for EP consultation. Data was collected from EPIC from 2021 to 2023 using the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD10-CM/PCS) codes to identify patients and comorbidities. A comparative analysis was conducted to determine the effectiveness of the BPA in increasing EP consults and cardiac device extraction procedures, as well as overall outcomes.

Results: A total of 447 patients were diagnosed with bacteremia and the presence of a CIED during the study period, with 178 before the BPA and 269 status post-BPA. The BPA resulted in a nonsignificant increase in EP consultations from 19.66% to 25.88% (p = 0.168) and device extractions from 9.55% to 13.75% (p = 0.182). EP consults were a significant predictor for device extractions (odds ratio (OR) = 9.4644, p < 0.0001). The mortality rate decreased from 17.42% to 14.13% (p = 0.419), and the 30-day readmission decreased from 14.37% to 12.41% (p = 0.652).

Conclusion: While the BPA did not show significant improvements, its implementation shows promise over time with positive trends in consults, extractions, and in-hospital mortality.

Keywords: bacteremia; cardiac device infection; cardiac implantable electronic device (cied); pacemaker; pacemaker infection.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Brenau University Review Board issued approval 2121050-1. The Brenau University Review Board has determined that this project is exempted from the Institutional Review Board (IRB) review according to federal regulations. . Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. This graph demonstrates a noticeable increase in the consultation rate post-BPA. The trend line emphasizes the upward shift, showing that the BPA contributed to more frequent consultations. This suggests that the advisory may have improved awareness and the process for consulting the cardiac electrophysiology service
Figure 2
Figure 2. This comparison illustrates an increase in the rate of device extractions after the BPA was introduced
BPA: Best practice advisory
Figure 3
Figure 3. This graph compares the influence of various patient characteristics and clinical factors on three outcomes: consultations, device extractions, and mortality. Each bar in the graphs represents the coefficient of a variable from a regression model, which estimates the effect of that variable on the outcome. The graphs are split to show the coefficients before (pre-BPA) and after (post-BPA) the implementation of the best practice advisory (BPA)
See this image and copyright information in PMC

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