Doctors won’t remove heart device implants that cause infection, putting patients’ lives at risk, according to a Duke University study.

A study of more than 1 million Medicare patients receiving cardiovascular implantable electronic devices found that only 18 percent of patients who developed a device infection ended up having their pacemaker or defibrillator removed.American Heart Association recommend Remove the infected device. Results of the study were presented at the 2022 American College of Cardiology Scientific Sessions.

“Not only is this important because for many patients, it’s a matter of life and death, and we know from previous research that it’s also a huge drain on healthcare resources,” said Dr. Jonathan Piccini, associate professor of medicine at Duke University. Director of Cardiac Electrophysiology at Duke Heart Center.

Doctor capturing patient with device Infect, 13% had their devices removed within six days. But most (more than 80%) did not remove the device until a month after the infection was confirmed. More comprehensive education of physicians is needed, Piccini said, because many are unaware of the immediate dangers and instead view the opportunity to treat patients with antibiotics first as a wait-and-see strategy to prevent avoidable surgeries.

“But on the other hand, it’s an opportunity for infection and progression to get worse before it’s finally resolved,” Piccini said.

The danger of leaving the device in place for long periods of time is that the risk of death increases over time. The findings showed that early tooth extraction was associated with a significantly lower risk of death compared with no extraction.

Discovering device infections can also be complicated. There is a list of clinical and other tests that, when considered together, can tell the doctor whether it is a definitive or a possible device infection. 2019, European Heart Rhythm Association post There are guidelines on how to spot infections in patients’ heart devices, but Piccini said the surgeons who implanted the devices — heart rhythm specialists — or infectious disease physicians were the only clinicians with extensive knowledge of the list.

But patients most often present with symptoms of infection, such as fever, chills, or vomiting, in urgent care centers, primary care offices, or emergency departments.

“While heart rhythm specialists put defibrillators or pacemakers on these patients, when they develop an infection they can show up in any part of the healthcare system, so it’s a Swiss cheese phenomenon where patients may end up seeing unknowns. This device needs to come out,” Piccini said.

Armed with these findings, Duke Clinical Institute physicians are launching a quality improvement demonstration project with the goal of providing the three participating hospitals with clear guidance on how to spot device infections and the steps to follow when making a diagnosis.

The project could involve instructing inpatient nurses to ask about any implanted cardiac devices and setting up alerts in electronic health records to keep doctors informed. There may also be a process of entering specific risk factors, which may increase a patient’s chances of developing an infection. These include a diagnosis of end-stage renal disease, certain anti-inflammatory prescription medications, poor kidney function, knowledge of accidental damage to the vessel wall during implant surgery or longer than usual.

The study, currently under peer review, included more than 1 million Medicare patients who received implants between 2006 and 2019. Over 11,000 people developed device infections, with a one-year survival rate of 68.4%. Both female and black patients were less likely to have their teeth extracted within 30 days of device infection.