The high cost of undertreating cardiac device infection

Undertreated cardiac device infections are a public health crisis

Cardiac implantable electronic devices (CIEDs), such as pacemakers and implantable defibrillators, save and extend lives. They are amazingly reliable and effective, but even the best tool comes with risks. As many as 1 in 20 patients with a CIED develops an infection within three years of implantation, and risk increases the longer a device has been implanted.

The science is clear about what to do: Patients with a CIED infection should be referred to a specialist with expertise in device extraction, and the CIED and all its components should be removed. This recommendation is supported by the American Heart Association, Heart Rhythm Society, British Heart Rhythm Society, European Society of Cardiology, and European Heart Rhythm Association. But despite the recommendations, many patients with CIED infection do not undergo complete system removal.

An American Heart Association initiative is working to change that by improving awareness, detection and appropriate treatment of CIED infections.

“CIED infections, although not frequent, are not rare either,” said Dr. Bruce Wilkoff, MD, planning group chairperson of the American Heart Association’s CIED initiative and director of cardiac pacing and tachyarrhythmia devices at Cleveland Clinic. “The cost is pain, hospitalization, surgery and, when not recognized and treated appropriately, death. Although effective therapies are available, many of these infections are not detected or treated according to guidelines.”

Some of the costs are direct: Average annual medical costs were 2.4 times higher for CIED patients with an infection, compared with those who did not experience an infection.[i] An analysis of claims through commercial insurers and Medicare supplement insurance estimated infections increase the per-patient cost of care from $62,256 to $110,141 for initial implants.[ii] Patients and their families face the greatest loss when device infections are not treated appropriately. Ultimately, when evidence-based treatment is not followed, infections can cause gaps and delays in care that lead to preventable illness, disability and death. An upcoming webinar, open to the public, will outline the incidence and impact of CIED infections and related gaps in care.

As part of the American Heart Association’s initiative, supported by Philips Image-Guided Therapy, a national summit was held in March to better understand the problem and begin to identify solutions to improve CIED infection treatment. More than 40 key subject matter experts, including patient advocates, patients and clinicians from infectious disease, electrophysiology, cardiology, hospital medicine, nephrology, surgery, and many others gathered to discuss:

  • identifying the gaps and potential action items, through an overall lens of addressing health disparities,
  • driving earlier detection and diagnosis,
  • promoting evidence-based treatment and management of CIED infection, and
  • raising awareness among patient and professional audiences.

Attendees represented a variety of organizations, including the American College of Cardiology, Arrhythmia Alliance, Hypertrophic Cardiomyopathy Association, Heart Rhythm Society, Mended Hearts, National Association of Hispanic Nurses, Association of Black Cardiologists, Black Nurses Rock, Infectious Diseases Society of America, The Joint Commission, National Black Nurses Association and National Quality Forum.

The summit presented a unique opportunity for collaborative discussion to advance better outcomes for patients and will serve as a springboard for the larger education initiative. This summer, the American Heart Association will release recommendations from the summit as part of a proceedings report for how to close the gap in care. In addition, insights from the summit will inform health care professional education disseminated across the Association’s expansive Get With The Guidelines® health care professional network.

“To treat CIED infections appropriately, you need a broad-based, interdisciplinary approach to gather and leverage the available experts,” Wilkoff said. “The American Heart Association is the perfect organization to get the message out more broadly. We can improve awareness, detection and treatment of CIED infections if we all work together.” 

The two-year initiative will conclude in June 2023. Learn more about this effort to drive evidence-based, equitable CIED infection care, and sign up to receive the summit proceedings report and access related educational resources at


[i] Eby et al. Economic impact of cardiac implantable electronic device infections: cost analysis at one year in a large U.S. health insurer. J Med Econ 2020;23:698-705.

[ii] Sohail MR, Eby EL, Ryan MP, Gunnarsson C, Wright LA, Greenspon AJ. Circ Arrhythm Electrophysiol. 2016;9:e003929.

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