Helen Banks1, Aleksandra Torbica1, Cinzia Valzania2, Yauheniya Varabyova3, Valentina Prevolnik Rupel4, Rod S Taylor5, Theresa Hunger6, Simon Walker7, Giuseppe Boriani8, Giovanni Fattore1,9. 1. Centre for Research on Health and Social Care Management, Bocconi University, Via Roentgen, 1, 20136 Milan, Italy. 2. Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Via Albertoni, 15, 40138 Bologna, Italy. 3. Hamburg Center for Health Economics, Universität Hamburg, Esplanade 36, 20354 Hamburg, Germany. 4. Institute for Economic Research, Kardeljeva plošcad 17, 1000 Ljubljana, Slovenia. 5. Evidence Synthesis & Modelling for Health Improvement, Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1?2LU, Exeter, UK. 6. Department of Public Health, Health Services Research and Health Technology Assessment, The University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Center I, 6060 Hall in Tyrol, Austria. 7. Centre for Health Economics, University of York, York, UK YO1?6EN, UK. 8. Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Via Del Pozzo 71, 41124 Modena, Italy. 9. Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy.
Abstract
Aims: Common methodologies for analysis of analogous data sets are needed for international comparisons of treatment and outcomes. This study tests using administrative hospital discharge (HD) databases in five European countries to investigate variation/trends in pacemaker (PM) and implantable cardioverter defibrillator (ICD) implant rates in terms of patient characteristics/management, device subtype, and initial implantation vs. replacement, and compares findings with existing literature and European Heart Rhythm Association (EHRA) reports. Methods and results: HD databases from 2008 to 2012 in Austria, England, Germany, Italy and Slovenia were interrogated to extract admissions (without patient identification) associated with PM and ICD implants and replacements, using direct cross-referencing of procedure codes and common methodology to compare aggregate data. 1 338 199 records revealed 212 952 PM and 62 567 ICD procedures/year on average for a 204.4 million combined population, a crude implant rate of about 104/100 000 inhabitants for PMs and 30.6 for ICDs. The first implant/replacement rate ratios were 81/24 (PMs) and 25/7 (ICDs). Rates have increased, with cardiac resynchronization therapy (CRT) subtypes for both devices rising dramatically. Significant between- and within-country variation persists in lengths of stay and rates (Germany highest, Slovenia lowest). Adjusting for age lessened differences for PM rates, scarcely affected ICDs. Male/female ratios remained stable at 56/44% (PMs) and 79/21% (ICDs). About 90% of patients were discharged to home; 85-100% were inpatient admissions. Conclusion: To aid in policymaking and track outcomes, HD administrative data provides a reliable, relatively cheap, methodology for tracking implant rates for PMs and ICDs across countries, as comparisons to EHRA data and the literature indicated.
Aims: Common methodologies for analysis of analogous data sets are needed for international comparisons of treatment and outcomes. This study tests using administrative hospital discharge (HD) databases in five European countries to investigate variation/trends in pacemaker (PM) and implantable cardioverter defibrillator (ICD) implant rates in terms of patient characteristics/management, device subtype, and initial implantation vs. replacement, and compares findings with existing literature and European Heart Rhythm Association (EHRA) reports. Methods and results: HD databases from 2008 to 2012 in Austria, England, Germany, Italy and Slovenia were interrogated to extract admissions (without patient identification) associated with PM and ICD implants and replacements, using direct cross-referencing of procedure codes and common methodology to compare aggregate data. 1 338 199 records revealed 212 952 PM and 62 567 ICD procedures/year on average for a 204.4 million combined population, a crude implant rate of about 104/100 000 inhabitants for PMs and 30.6 for ICDs. The first implant/replacement rate ratios were 81/24 (PMs) and 25/7 (ICDs). Rates have increased, with cardiac resynchronization therapy (CRT) subtypes for both devices rising dramatically. Significant between- and within-country variation persists in lengths of stay and rates (Germany highest, Slovenia lowest). Adjusting for age lessened differences for PM rates, scarcely affected ICDs. Male/female ratios remained stable at 56/44% (PMs) and 79/21% (ICDs). About 90% of patients were discharged to home; 85-100% were inpatient admissions. Conclusion: To aid in policymaking and track outcomes, HD administrative data provides a reliable, relatively cheap, methodology for tracking implant rates for PMs and ICDs across countries, as comparisons to EHRA data and the literature indicated.
Authors: Lucy Bolt; Maria M Wertli; Alan G Haynes; Nicolas Rodondi; Arnaud Chiolero; Radoslaw Panczak; Drahomir Aujesky Journal: PLoS One Date: 2022-02-16 Impact factor: 3.240