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

Gabriel Velez Oquendo; Riaz Mahmood; Joon Ahn; Shane Robinson

doi:10.7759/cureus.74012

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

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

Authors

Gabriel Velez Oquendo¹, Riaz Mahmood¹, Joon Ahn², Shane Robinson³

Affiliations

¹ Internal Medicine, Northeast Georgia Medical Center Gainesville, Gainesville, USA.
² Electrophysiology, Northeast Georgia Medical Center Gainesville, Gainesville, USA.
³ Research, Northeast Georgia Medical Center Gainesville, Gainesville, USA.

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.