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02.08.2022 | original article

Impact of socioeconomic aspects on cardiac implantable electronic device treatment and application of the EHRA guidelines

A European comparison

verfasst von: Marwin Bannehr, David Reiners, Michael Lichtenauer, Kristen Kopp, Peter Jirak, Christian Georgi, Christian Butter, MD Christoph Edlinger

Erschienen in: Wiener klinische Wochenschrift

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Summary

Background

Cardiac implantable electronic devices (CIED) have become an indispensable part in everyday clinical practice in cardiology. The indications for CIED implantation are based on the guidelines of the European Heart Rhythm Association (EHRA). Nevertheless, numbers of CIED implantations in Europe are subject to considerable differences. We hypothesized that reimbursements linked to the respective health systems may influence implantation behavior.

Methods

Based on the EHRA White Book 2017, CIED implantation data as well as socioeconomic key figures were collected, in particular gross domestic product (GDP) and share of gross domestic product spent on healthcare.
Implantation numbers for pacemakers, implantable cardioverter defibrillators and cardiac resynchronization treatment as well as all in total were assessed, compared with the health care expenditures and visualized using heat maps.

Results

Total implantation numbers per 100,000 inhabitants varied from 196.53 (Germany) to 2.81 (Kosovo). Higher implantation numbers correlated moderately with a higher GDP (r = 0.456, p 0.002) and higher health expenditure (r = 0.586, p < 0.001). The annual financial resources per inhabitant were also subject to fluctuations ranging from 9476 $ (Switzerland) to 140 $ (Ukraine); however, there were countries with high financial means, such as Switzerland or Scandinavian countries, which showed significantly lower implantation rates.

Conclusion

There were considerable differences in CIED implantations in Europe. These seem to be explained in part by socioeconomic disparities within Europe. Also, a potential influence by the respective remuneration system is likely.
Literatur
1.
Zurück zum Zitat Cabanas-Grandio P, et al. Quality of life of patients undergoing conventional vs leadless pacemaker implantation: a multicenter observational study. J Cardiovasc Electrophysiol. 2020;31(1):330–6. CrossRef Cabanas-Grandio P, et al. Quality of life of patients undergoing conventional vs leadless pacemaker implantation: a multicenter observational study. J Cardiovasc Electrophysiol. 2020;31(1):330–6. CrossRef
2.
Zurück zum Zitat Cleland JG, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005;352(15):1539–49. CrossRef Cleland JG, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005;352(15):1539–49. CrossRef
3.
Zurück zum Zitat Edhag O, Swahn A. Prognosis of patients with complete heart block or arrhythmic syncope who were not treated with artificial pacemakers. A long-term follow-up study of 101 patients. Acta Med Scand. 1976;200(6):457–63. PubMed Edhag O, Swahn A. Prognosis of patients with complete heart block or arrhythmic syncope who were not treated with artificial pacemakers. A long-term follow-up study of 101 patients. Acta Med Scand. 1976;200(6):457–63. PubMed
4.
Zurück zum Zitat Johansson BW. Complete heart block. A clinical, hemodynamic and pharmacological study in patients with and without an artificial pacemaker. Acta Med Scand Suppl. 1966;451:1–127. PubMed Johansson BW. Complete heart block. A clinical, hemodynamic and pharmacological study in patients with and without an artificial pacemaker. Acta Med Scand Suppl. 1966;451:1–127. PubMed
5.
Zurück zum Zitat Moss AJ, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med. 1996;335(26):1933–40. CrossRef Moss AJ, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med. 1996;335(26):1933–40. CrossRef
6.
Zurück zum Zitat Tomzik J, et al. Quality of life in patients with an Implantable cardioverter defibrillator: a systematic review. Front Cardiovasc Med. 2015;2:34. CrossRef Tomzik J, et al. Quality of life in patients with an Implantable cardioverter defibrillator: a systematic review. Front Cardiovasc Med. 2015;2:34. CrossRef
7.
Zurück zum Zitat Barbar T, et al. Strategies to prevent cardiac Implantable electronic device infection. J Innov Card Rhythm Manag. 2020;11(1):3949–56. CrossRef Barbar T, et al. Strategies to prevent cardiac Implantable electronic device infection. J Innov Card Rhythm Manag. 2020;11(1):3949–56. CrossRef
8.
Zurück zum Zitat Blomström-Lundqvist, C., et al., European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Europace, 2020. 22(4): p. 515–549. Blomström-Lundqvist, C., et al., European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Europace, 2020. 22(4): p. 515–549.
9.
Zurück zum Zitat Kirkfeldt RE, et al. Risk factors for lead complications in cardiac pacing: a population-based cohort study of 28,860 Danish patients. Heart Rhythm. 2011;8(10):1622–8. CrossRef Kirkfeldt RE, et al. Risk factors for lead complications in cardiac pacing: a population-based cohort study of 28,860 Danish patients. Heart Rhythm. 2011;8(10):1622–8. CrossRef
10.
Zurück zum Zitat Udo EO, et al. Incidence and predictors of short- and long-term complications in pacemaker therapy: the FOLLOWPACE study. Heart Rhythm. 2012;9(5):728–35. CrossRef Udo EO, et al. Incidence and predictors of short- and long-term complications in pacemaker therapy: the FOLLOWPACE study. Heart Rhythm. 2012;9(5):728–35. CrossRef
11.
Zurück zum Zitat Goette A, Sommer P. Infections of cardiac implantable electronic devices: still a cause of high mortality. Europace. 2021;23(Supplement_4):iv1–iv2. CrossRef Goette A, Sommer P. Infections of cardiac implantable electronic devices: still a cause of high mortality. Europace. 2021;23(Supplement_4):iv1–iv2. CrossRef
12.
Zurück zum Zitat Brignole M, et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J. 2013;34(29):2281–329. CrossRef Brignole M, et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J. 2013;34(29):2281–329. CrossRef
13.
Zurück zum Zitat Kusumoto FM, et al. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay. J Am Coll Cardiol. 2019;74(7):e51–e156. CrossRef Kusumoto FM, et al. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay. J Am Coll Cardiol. 2019;74(7):e51–e156. CrossRef
15.
Zurück zum Zitat Thomson S, et al. Private health insurance: history, politics and performance. Cambridge: University Press; 2020. CrossRef Thomson S, et al. Private health insurance: history, politics and performance. Cambridge: University Press; 2020. CrossRef
16.
Zurück zum Zitat Mossialos E, Thomson SMS. Voluntary health insurance in the European Union: a critical assessment. Int J Health Serv. 2002;32(1):19–88. CrossRef Mossialos E, Thomson SMS. Voluntary health insurance in the European Union: a critical assessment. Int J Health Serv. 2002;32(1):19–88. CrossRef
17.
Zurück zum Zitat Boriani G, et al. Device therapy and hospital reimbursement practices across European countries: a heterogeneous scenario. Europace. 2011;13(suppl_2):ii59–ii65. CrossRef Boriani G, et al. Device therapy and hospital reimbursement practices across European countries: a heterogeneous scenario. Europace. 2011;13(suppl_2):ii59–ii65. CrossRef
18.
Zurück zum Zitat Raatikainen MJP, et al. A decade of information on the use of cardiac Implantable electronic devices and Interventional electrophysiological procedures in the European society of cardiology countries: 2017 report from the European heart rhythm association. Europace. 2017;19(suppl_2):ii1–ii90. CrossRef Raatikainen MJP, et al. A decade of information on the use of cardiac Implantable electronic devices and Interventional electrophysiological procedures in the European society of cardiology countries: 2017 report from the European heart rhythm association. Europace. 2017;19(suppl_2):ii1–ii90. CrossRef
19.
Zurück zum Zitat Dissmann W, de Ridder M. The soft science of German cardiology. Lancet. 2002;359(9322):2027–9. CrossRef Dissmann W, de Ridder M. The soft science of German cardiology. Lancet. 2002;359(9322):2027–9. CrossRef
20.
Zurück zum Zitat Wengler A, Nimptsch U, Mansky T. Hip and knee replacement in Germany and the USA: analysis of individual inpatient data from German and US hospitals for the years 2005 to 2011. Dtsch Arztebl Int. 2014;111(23–24):407–16. PubMedPubMedCentral Wengler A, Nimptsch U, Mansky T. Hip and knee replacement in Germany and the USA: analysis of individual inpatient data from German and US hospitals for the years 2005 to 2011. Dtsch Arztebl Int. 2014;111(23–24):407–16. PubMedPubMedCentral
21.
Zurück zum Zitat Geissler A, et al. Germany: understanding G‑DRGs. Diagnosis-related groups in Europe: moving towards transparency, efficiency and quality in hospitals. 2011. pp. 243–72. Geissler A, et al. Germany: understanding G‑DRGs. Diagnosis-related groups in Europe: moving towards transparency, efficiency and quality in hospitals. 2011. pp. 243–72.
23.
Zurück zum Zitat Kutz A, et al. Association of the Swiss diagnosis-related group reimbursement system with length of stay, mortality, and readmission rates in hospitalized adult patients. JAMA Netw Open. 2019;2(2):e188332. CrossRef Kutz A, et al. Association of the Swiss diagnosis-related group reimbursement system with length of stay, mortality, and readmission rates in hospitalized adult patients. JAMA Netw Open. 2019;2(2):e188332. CrossRef
25.
Zurück zum Zitat Gadler F, Valzania C, Linde C. Current use of implantable electrical devices in Sweden: data from the Swedish pacemaker and implantable cardioverter-defibrillator registry. Europace. 2015;17(1):69–77. CrossRef Gadler F, Valzania C, Linde C. Current use of implantable electrical devices in Sweden: data from the Swedish pacemaker and implantable cardioverter-defibrillator registry. Europace. 2015;17(1):69–77. CrossRef
26.
Zurück zum Zitat Markewitz A. Jahresbericht 2013 des Deutschen Herzschrittmacher- und Defibrillatorregisters, Teil 2 – Implantierbare Cardioverter-Defibrillatoren. Herzschr Elektrophys. 2015;26(4):399–423. CrossRef Markewitz A. Jahresbericht 2013 des Deutschen Herzschrittmacher- und Defibrillatorregisters, Teil 2 – Implantierbare Cardioverter-Defibrillatoren. Herzschr Elektrophys. 2015;26(4):399–423. CrossRef
27.
Zurück zum Zitat Teimourizad A, et al. Cost-effectiveness of cardiac resynchronization therapy plus an implantable cardioverter-defibrillator in patients with heart failure: a systematic review. Cost Eff Resour Alloc. 2021;19(1):31. CrossRef Teimourizad A, et al. Cost-effectiveness of cardiac resynchronization therapy plus an implantable cardioverter-defibrillator in patients with heart failure: a systematic review. Cost Eff Resour Alloc. 2021;19(1):31. CrossRef
28.
Zurück zum Zitat Crespo C, et al. Optimisation of cardiac resynchronisation therapy device selection guided by cardiac magnetic resonance imaging: Cost-effectiveness analysis. Eur J Prev Cardiol. 2020;27(6):622–32. CrossRef Crespo C, et al. Optimisation of cardiac resynchronisation therapy device selection guided by cardiac magnetic resonance imaging: Cost-effectiveness analysis. Eur J Prev Cardiol. 2020;27(6):622–32. CrossRef
29.
Zurück zum Zitat Glikson M, et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: Developed by the Task Force on cardiac pacing and cardiac resynchronization therapy of the European Society of Cardiology (ESC) With the special contribution of the European Heart Rhythm Association (EHRA). Rev Esp Cardiol (engl Ed). 2022;75(5):430. CrossRef Glikson M, et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: Developed by the Task Force on cardiac pacing and cardiac resynchronization therapy of the European Society of Cardiology (ESC) With the special contribution of the European Heart Rhythm Association (EHRA). Rev Esp Cardiol (engl Ed). 2022;75(5):430. CrossRef
30.
Zurück zum Zitat Schnell-Inderst P, et al. Health technology assessment of medical devices: What is different? An overview of three European projects. Z Evid Fortbild Qual Gesundhwes. 2015;109(4–5):309–18. CrossRef Schnell-Inderst P, et al. Health technology assessment of medical devices: What is different? An overview of three European projects. Z Evid Fortbild Qual Gesundhwes. 2015;109(4–5):309–18. CrossRef
Metadaten
Titel
Impact of socioeconomic aspects on cardiac implantable electronic device treatment and application of the EHRA guidelines
A European comparison
verfasst von
Marwin Bannehr
David Reiners
Michael Lichtenauer
Kristen Kopp
Peter Jirak
Christian Georgi
Christian Butter
MD Christoph Edlinger
Publikationsdatum
02.08.2022
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-022-02056-5