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Cardiovascular disease (CVD) continues to be the primary cause of mortality and morbidity globally with middle-aged women presenting with additional and possibly, overlooked risk factors.1 Despite several awareness programmes, there remain several gaps in the political education and representation needs of this group, which includes those from low socioeconomic status (SES) and culturally diverse backgrounds. These […]

98/Cardiac implantable electronic device infections: multicentre validation of a novel risk score and its cost–utility implications for antimicrobial envelope use

E Maclean (Presenting Author) – St Bartholomew’s Hospital, London; K Mahtani – St. Bartholomew’s Hospital, London; S Honarbakhsh – St. Bartholomew’s Hospital, London; C Butcher – St. Bartholomew’s Hospital, London; N Ahluwalia – St. Bartholomew’s Hospital, London; ASC Dennis – St. Bartholomew’s Hospital, London; P Waddingham – St. Bartholomew’s Hospital, London; A Creta – St. Bartholomew’s Hospital, London; M Finlay – St. Bartholomew’s Hospital, London; M Elliott – St. Thomas’ Hospital, London; V Mehta – St. Thomas’ Hospital, London; N Wijesuriya – St. Thomas’ Hospital, London; O Shaikh – Royal Papworth Hospital, Cambridge; M Zaw – Royal Papworth Hospital, Cambridge; CN Ranmuthu – Royal Papworth Hospital, Cambridge; CR Ranmuthu – Royal Papworth Hospital, Cambridge; RJ Schilling – St. Bartholomew’s Hospital, London; PD Lambiase – St. Bartholomew’s Hospital, London; MJ Earley – St. Bartholomew’s Hospital, London; P Moore – St. Bartholomew’s Hospital, London; A Muthumala – St. Bartholomew’s Hospital, London; S Sporton – St. Bartholomew’s Hospital, London; RJ Hunter – St. Bartholomew’s Hospital, London; C Rinaldi – St. Thomas’ Hospital, London; JM Behar – St. Thomas’ Hospital, London; C Martin – Royal Papworth Hospital, Cambridge; C Monkhouse – St. Bartholomew’s Hospital, London; A Chow – St. Bartholomew’s Hospital, London
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Published Online: Oct 9th 2012 European Journal of Arrhythmia & Electrophysiology. 2022;8(Suppl. 1):abstr98
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Article

Introduction: Antimicrobial envelopes reduce the incidence of cardiac implantable electronic device (CIED) infections; however, patient selection strategies are poorly defined and cost–utility data are limited.

Methods: In a preliminary internal analysis, we examined the factors associated with infection for all transvenous CIED implants, generator changes and non-infected lead interventions at a single tertiary centre from 2016 to 2019. The primary outcome was hospitalisation for device infection within 12 months. We subsequently developed a novel risk score (BLISTER) and, in a multicentre validation cohort, compared prognostic utility versus the PADIT score. Finally, both scores were tested as gatekeepers in cost–utility modelling of the TYRX antimicrobial envelope; quality-adjusted life-year (QALY) increments were extrapolated from analysis of EQ-5D-3L data for all UK patients enrolled in the WRAP-IT trial.

Results: A total of 6,035 patients underwent 7,383 procedures; CIED infection occurred in 59 individuals (0.8%). In addition to the PADIT score constituents, lead extraction (HR 3.3 [1.9–6.1]; p<0.0001), C-reactive protein >50 mg/L (HR 3.0 [1.4–6.4]; p=0.005), re-intervention within 2 years (HR 10.1 [5.6–17.9]; p<0.0001), and procedure duration over 2 hours (HR 2.6 [1.6–4.1]; p=0.001) were independent predictors of infection, and were incorporated into the novel BLISTER score. In a validation cohort comprising 2,701 additional patients from three tertiary centres, BLISTER demonstrated superior prognostic utility versus PADIT (AUC 0.83 vs 0.73; p=0.01). The optimum cost–utility model assigned TYRX envelopes to all patients with a BLISTER score ≥6, and predicted a reduction in infections (0.55% versus 0.8%; p=0.033; number needed to treat 63) with a cost per QALY gained of £24,581.

Conclusions: The BLISTER score was a powerful predictor of infection in a heterogeneous CIED population and may facilitate cost-effective TYRX envelope allocation.

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