Chapter 1 12 Discontinuing DOACs 24–48 h before surgery depending on their renal function, or targeting an international normalized ratio of 2.0 to 2.5, and avoiding heparin bridging were important changes in anticoagulation regimen over the last decade (2013-2023) (18). The increased use of DOACs may have further influenced the risk profile in CIED procedures in our center. In this thesis we evaluated this change in anticoagulation regimen for CIED related surgery in our patient population. Another key complication is the risk of a pocket infection. It is associated with increased mortality risk and substantial morbidity (19, 20). A pocket infection may necessitate device and lead extraction to prevent endocarditis, which leads to higher costs, a higher risk profile and a significant burden to the patient. In reducing the risk of infections the use of antibiotic prophylaxis, chlorhexidine skin preparation, delaying the procedure in case of fever, avoidance of heparin bridging, avoidance of pocket hematoma, the use of strict sterile techniques, and having experienced operators are important preventive measures (21). Antibacterial envelopes may be used in highrisk patients. However, they are associated with high costs (22). Currently, there is no reimbursement for the antibacterial envelope in the Netherlands. Risk stratification with risk score calculators can be useful in identifying these high-risk patients (2325). The identification of patients may be aided using risk calculators such as the PADIT (Prevention of Arrhythmia Device Infection Trial)-score (26, 27). In this thesis we evaluated the usefulness of the PADIT score in clinical practice. 1.3 Patient empowerment: Use of eHealth as discharge aid Finally, in this thesis we would like to address the importance of involving the patient in his or her treatment strategy. Patient centred care models encourage shared decision-making between patients and healthcare providers (1, 28). Patient empowerment may be impacted by knowledge about early recognition of possible complications. Patients who are engaged in their care are more likely to adhere therapy, helping identification of irregularities or complications promptly (28). Health literacy and disease self-management can benefit from eHealth applications (29, 30). In this thesis we evaluated a computer generated personalized discharge letter as a discharge aid in comparison to the standard discharge information. As a result of advances in therapy and changes in care pathways a reduction in (re)hospitalizations was observed in the Erasmus MC. The Erasmus MC, being a
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