Abstract 211: A Patient-Centered Approach to Improve Outcomes after Cardiac Electrophysiological Device Implantation
Objective: Infection associated with cardiac implantable electrophysiological device (CIED) implantation or revision occurred in our facility in 17.8% of CIED recipients, leading to hospitalization and device explantation in 5.2% of patients. Our objective was to reduce the incidence of CIED-associated infections, number of hospitalizations and device explantations by 25%.
Methods: At baseline, a peri-procedural follow-up occurred on as needed basis. A new patient-centered program was initiated and lead by a nurse-practitioner (NP) (refer to flow map). Patients were seen 1 week prior to CIED implantation, provided with general information, familiarized with the procedure and self-care techniques. On the day of CIED implantation, NP visited patients at bedside and provided a self-care checklist. A follow up visit was scheduled 1 week after the procedure to provide local wound care, discuss symptom monitoring, activity limitations and review self-management techniques supported by a checklist. If any evidence of CIED site infection was discovered, antibiotics were initiated with a weekly follow-up until infection was resolved. If no evidence of infection was noted, further plan of care consisted of a consultation for the patients hospitalized with CIED-related infections by NP, and a chart review at 6 months after implantation in cases when no hospitalizations occurred. Data on incidence of post-CIED implantation infections, hospitalizations and explantations was collected by chart review of 152 patients prior and 66 patients after establishment of the patient-centered program.
Results: With initiation of our patient-centered program, incidence of CIED site infections was reduced by 23.5%, and both, the number of hospitalizations and CIED explantations, decreased by 42.4%.
Conclusions: Patient education and engagement in post-CIED implantation care combined with a close surveillance by NP can be an effective tool to improve patient outcomes by reducing frequency of CIED site infections, need for hospitalization and device explantation.
Author Disclosures: N. Hernandez: None. A.P. Aiken: None. J.M. Mitchell: None.
- © 2014 by American Heart Association, Inc.