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      Trends in the incidence and prevalence of cardiac pacemaker insertions in an ageing population

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          Abstract

          Objectives

          To determine contemporary population estimates of the prevalence of cardiac permanent pacemaker (PPM) insertions.

          Methods

          A population-based observational study using linked hospital morbidity and death registry data from Western Australia (WA) to identify all incident cases of PPM insertion for adults aged 18 years or older. Prevalence rates were calculated by age and sex for the years 1995–2009 for the WA population.

          Results

          There were 9782 PPMs inserted during 1995–2009. Prevalence rose across the study period, exceeding 1 in 50 among people aged 75 or older from 2005. This was underpinned by incidence rates which rose with age, being highest in those 85 years or older; over 500/100 000 for men throughout, and over 200/100 000 for women. Rates for patients over 75 were more than double the rates for those aged 65–74 years. Women were around 40% of cases overall. The use of dual-chamber and triple-chamber pacing increased across the study period. A cardiac resynchronisation defibrillator was implanted for 58% of patients treated with cardiac resynchronisation therapy.

          Conclusions

          Rates of insertion and prevalence of PPM continue to rise with the ageing population in WA. As equilibrium has probably not been reached, the demand for pacing services in similarly well-developed economies is likely to continue to grow.

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          The 11th world survey of cardiac pacing and implantable cardioverter-defibrillators: calendar year 2009--a World Society of Arrhythmia's project.

          Harry G Mond, Alessandro Proclemer (2011)
          A worldwide cardiac pacing and implantable cardioverter-defibrillator (ICD) survey was undertaken for calendar year 2009 and compared to a similar survey conducted in 2005. There were contributions from 61 countries: 25 from Europe, 20 from the Asia Pacific region, seven from the Middle East and Africa, and nine from the Americas. The 2009 survey involved 1,002,664 pacemakers, with 737,840 new implants and 264,824 replacements. The United States of America (USA) had the largest number of cardiac pacemaker implants (225,567) and Germany the highest new implants per million population (927). Virtually all countries showed increases in implant numbers over the 4 years between surveys. High-degree atrioventricular block and sick sinus syndrome remain the major indications for implantation of a cardiac pacemaker. There remains a high percentage of VVI(R) pacing in the developing countries, although compared to the 2005 survey, virtually all countries had increased the percentage of DDDR implants. Pacing leads were predominantly transvenous, bipolar, and active fixation. The survey also involved 328,027 ICDs, with 222,407 new implants and 105,620 replacements. Virtually all countries surveyed showed a significant rise in the use of ICDs with the largest implanter being the USA (133,262) with 434 new implants per million population. This was the largest pacing and ICD survey ever performed, because of mainly a group of loyal enthusiastic survey coordinators. It encompasses more than 80% of all the pacemakers and ICDs implanted worldwide during 2009. ©2011, The Authors. Journal compilation ©2011 Wiley Periodicals, Inc.
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            Cardiac Device Implantation in the United States from 1997 through 2004: A Population-based Analysis

            Chunliu Zhan, William Baine, Artyom Sedrakyan … (2007)
            OBJECTIVE Use of cardiac devices has been increasing rapidly along with concerns over their safety and effectiveness. This study used hospital administrative data to assess cardiac device implantations in the United States, selected perioperative outcomes, and associated patient and hospital characteristics. METHODS We screened hospital discharge abstracts from the 1997–2004 Healthcare Cost and Utilization Project Nationwide Inpatient Samples. Patients who underwent implantation of pacemaker (PM), automatic cardioverter/defibrillator (AICD), or cardiac resynchronization therapy pacemaker (CRT-P) or defibrillator (CRT-D) were identified using ICD-9-CM procedure codes. Outcomes ascertainable from these data and associated hospital and patient characteristics were analyzed. MEASUREMENTS AND MAIN RESULTS Approximately 67,000 AICDs and 178,000 PMs were implanted in 2004 in the United States, increasing 60% and 19%, respectively, since 1997. After FDA approval in 2001, CRT-D and CRT-P reached 33,000 and 7,000 units per year in the United States in 2004. About 70% of the patients were aged 65 years or older, and more than 75% of the patients had 1 or more comorbid diseases. There were substantial decreases in length of stay, but marked increases in charges, for example, the length of stay of AICD implantations halved (from 9.9 days in 1997 to 5.2 days in 2004), whereas charges nearly doubled (from $66,000 in 1997 to $117,000 in 2004). Rates of in-hospital mortality and complications fluctuated slightly during the period. Overall, adverse outcomes were associated with advanced age, comorbid conditions, and emergency admissions, and there was no consistent volume–outcome relationship across different outcome measures and patient groups. CONCLUSIONS The numbers of cardiac device implantations in the United States steadily increased from 1997 to 2004, with substantial reductions in length of stay and increases in charges. Rates of in-hospital mortality and complications changed slightly over the years and were associated primarily with patient frailty.
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              Implantation trends and patient profiles for pacemakers and implantable cardioverter defibrillators in the United States: 1993-2006.

              Edmund Lau, D Frisch, Sara Ochoa … (2010)
              Prior studies of cardiac rhythm management devices (pacemakers [PM] and implantable cardioverter defibrillators [ICD]) utilization in the United States have been limited to the Medicare population. We evaluated the national trends for the implantation of PMs and ICDs including the burden of device replacement. The Nationwide Inpatient Sample was queried to identify PM and ICD patients between 1993 and 2006 using ICD-9-CM codes, including demographics, health profile, and economic data. The Charlson Comorbidity Index (CCI) and replacement burden were calculated, and changes over time studied. From 1993 to 2006, 2.4 million patients received a primary PM and 0.8 million received an ICD, while there were 369,000 PM replacements and 74,000 ICD replacements. Women comprised 49% of PM and 24% of ICD patients. The mean ICD replacement burden was 8.4% (range 5-22%) and decreased significantly over time (P < 0.0001) while the replacement burden for PMs was constant (mean = 13.4%, range 11-16%). ICD patients had more comorbidities than PM patients (CCI: 0.8 vs 1.1, P < 0.0001). The replacement burden for PMs has remained constant, while the replacement burden for ICDs has decreased. This is likely due to the stability of the patient population receiving PMs and technology maturity. Alternatively, the indications for ICD implantation have broadened, resulting in an increased number of primary ICD implantations. The age and comorbidities are increasing in those patients receiving ICDs while the PM population is stable. These data suggest that monitoring of replacement burden is warranted, given the changing populations, their disparate clinical outcomes, and economic implications to the health care system.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Open Heart
                Journal ID (iso-abbrev): Open Heart
                Journal ID (hwp): openhrt
                Journal ID (publisher-id): openheart
                Title: Open Heart
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2053-3624
                Publication date Collection: 2014
                Publication date (Electronic): 10 December 2014
                Volume: 1
                Issue: 1
                Electronic Location Identifier: e000177
                Affiliations
                [1 ]School of Population Health, The University of Western Australia , Perth, Western Australia, Australia
                [2 ]Department of Cardiovascular Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
                Author notes
                [Correspondence to ] Dr Pamela J Bradshaw; pamela.bradshaw@.uwa.edu.au
                Author information
                http://orcid.org/0000-0003-2560-2537
                Article
                Publisher ID: openhrt-2014-000177
                DOI: 10.1136/openhrt-2014-000177
                PMC ID: 4265147
                PubMed ID: 25512875
                SO-VID: 04429727-e542-4a30-af01-29b6489b52b2
                Copyright © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                Date received : 31 July 2014
                Date revision received : 11 November 2014
                Date accepted : 18 November 2014
                Categories
                Subject: Health Care Delivery, Economics and Global Health Care
                Subject: 1506
                Series title: Original research article

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