Burden of disease and costs of infections associated with cardiac implantable electronic devices

Introduction: Infections are complications of Cardiac Implantable Electronic Device (CIED) procedures, associated with high mortality (20–25% at 1 year), long hospitalizations (23–30 days), and high costs for health-care systems (often higher than 30.000 €). The incidence rates are around 1–4%. Prevention strategies appear to be the best approach for minimizing the occurrence of CIED infections, but in real-world, the recommendations for the best practices are not always followed. Among the recommended preventive measures, the antibacterial envelope has proven to be effective in reducing CIED-related infections. Areas covered: Published studies investigate the role of antibacterial envelopes in infection prevention and the use of infection risk scores to select high-risk patients undergoing CIED implantation/replacement who can benefit from additional preventive measures. Expert opinion: A proficient selection of the best candidates for the antibacterial envelope can be the basis for reducing the healthcare system’s costs, in line with the principles of cost-effectiveness. Risk scores have been developed to select patients at high risk of CIED infections and their use appears simple and more complete than individual factors alone. Among them, the PADIT score seems to be effective in selecting patients eligible for antibacterial envelope insertion, with a good cost-effectiveness profile.