REview and improvement of Cardiac implanTable device InFection management qualitY initiative: Primary Results of the RECTIFY Study
S Pokorney, R Young, H Al-Khalidi, C Lambert, M Tillery, A Lin, R Mehta, S Misra, G Peigh, D Chew, L M Epstein, C B Lundqvist, J P Piccini, M R Sohail, C B GrangerAbstract
Background/Introduction
Cardiac implantable electronic device (CIED) infections are associated with high morbidity, mortality, and healthcare utilization. Hardware removal for CIED infections carries a Class I guideline recommendation, yet extraction rates are low.
Purpose
REview and improvement of Cardiac implanTable device InFection qualitY initiative (RECTIFY) is a multi-center demonstration project aimed to improve early identification of CIED infections and minimize delays to guideline-driven management with hardware removal by addressing health system-wide barriers.
Methods
This prospective interventional study, conducted across three U.S health systems (one academic, one community, and one integrated academic/community), employed scalable quality improvement (QI) interventions: engagement of a multidisciplinary team, retrospective evaluation of barriers to treatment, and automated electronic medical record alerts.The primary outcome was the change in number of patients with hardware removal for CIED infection that occurred during the 1-year pre-intervention retrospective assessment and the 1-year post-intervention assessment.
Results
The number of patients with CIED infection and adherence to Class I recommendations for hardware removal increased from 38 (n=11 [28.9%] pocket infections; n=27 [71.1%] systemic infections) in the pre-intervention period to 56 (n=13 [23.2%] pocket infections; n=43 [76.8%] systemic infections) in the post-intervention (47.4% increase) [Figure 1]. The median time from CIED infection presentation to hardware removal was 8.0 days (IQR 3.0, 17.0) and 7.5 days (IQR 3.0, 11.0) in the pre- and post-intervention, respectively. Infectious disease consultation went from 50.0% (n=19) to 98.2% (n=55) in the pre- and post-intervention, respectively.
Conclusion
Implementation of the RECTIFY intervention was associated with higher adherence to guideline-directed hardware removal. Efforts to facilitate widespread dissemination of the scalable RECTIFY QI like interventions are needed, and future studies are required to assess the impact of this intervention on mortality and healthcare utilization.