Cardiac implantable electronic device infection awareness and management: nationwide survey amongst general practitioners.

INTRODUCTION

Cardiac implantable electronic device (CIED) infections are associated with substantial morbidity and mortality, and early recognition with referral for device extraction is crucial for optimal outcomes. General practitioners (GPs) are essential for long-term follow-up, yet their adherence to international guidelines remains poorly defined. This survey aimed to assess GPs' levels of awareness and clinical management of CIED infections.

METHODS

A nationwide survey endorsed by the Electrophysiology and Cardiac Pacing Study Group of the Italian Federation of Cardiology was sent to GPs throughout Italy. The questionnaire explored epidemiology, prognosis, clinical scenarios, preventive strategies, therapeutic pathways, and educational background regarding CIED infections.

RESULTS

A total of 183 GPs from 10 Italian regions participated. Most respondents (62.8%) correctly estimated CIED infection incidence at 1-2%. However, two-thirds (122 GPs, 66.6%) considered conservative management to be associated with good outcomes, and only 28.4% recognized CIED infection as a condition with a poor prognosis. While 93.4% identified systemic inflammatory symptoms as warning signs, fewer than one-third would refer febrile CIED carriers to an electrophysiology specialist. Preventive strategies were heterogeneous, with more than half (54.1%) prescribing antibiotic prophylaxis before dental procedures. Only six GPs (3.8%) reported having received adequate training or dedicated education courses on CIED infections during their educational pathway.

CONCLUSIONS

Italian GPs demonstrate reasonable epidemiological awareness of CIED infections. However, major gaps exist in prognostic understanding, diagnostic referral, prevention, and therapeutic alignment with guidelines. These findings highlight the need for structured educational programs and shared care pathways between primary care and electrophysiology services.