Abstract
OBJECTIVE: The aim of this study was to conduct a survey of cardiac device implanting physicians to report utilisation trends, barriers and attitudes around the use of antibiotic envelope utilisation in the UK. DESIGN: An online survey devised by an implanting physician focus group, which included a mixture of multiple-choice and open text questions, was sent via email to UK-based physicians. PARTICIPANTS: 500 implanting physicians across 159 sites in the UK, identified from the National Institute for Cardiovascular Outcomes Research Database. RESULTS: Responses were received from 117 participants (79% of whom were consultant cardiologists). The TYRX absorbable antibiotic envelope was most commonly used for device upgrades, compared with de novo pacemakers, cardiac resynchronisation therapy-pacemakers or -defibrillators (CRT-P/CRT-D) implants and generator replacements. A limited number (13%) of respondents used the PADIT (Prevention Of Arrhythmia Device Infection Trial) score to guide their use of TYRX while 31% of respondents were unaware of the score. Several risk factors (early pocket re-intervention, previous device infection and procedural duration) were reported as the most important factors in consideration of TYRX use; however, these are not included in the PADIT score. Key barriers to adoption included cost-effectiveness and lack of compelling clinical data and guidelines. Technical concerns were reported by 27% of respondents, translating into reduced utilisation in clinical practice. CONCLUSION: This survey provides a snapshot of antibiotic envelope utilisation across device implanters in the UK. The PADIT score does not reflect the key decision-making factors reported by our surveyed cohort. There remains significant variation in patient selection and practical techniques as well as uncertainty surrounding the clinical evidence and cost-effectiveness of the TYRX envelope.