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Cardiac device implantation in the United States from 1997 through 2004: a population-based analysis
Chunliu Zhan1, William B Baine, Artyom Sedrakyan
1Center for Outcomes and Evidence, Agency for Healthcare Research and Quality, Rockville, MD, USA. chunliu.zhan@ahrq.hhs.gov
Insights
Cardiac device implantations, including pacemakers and defibrillators, rose significantly from 1997-2004. While hospital stays shortened, costs increased, with outcomes tied to patient health, not hospital volume.
Area of Science:
- Cardiology
- Health Services Research
- Medical Device Technology
Background:
- Cardiac device use is increasing, raising safety and effectiveness concerns.
- Hospital administrative data provides insights into device implantation trends and outcomes.
Purpose of the Study:
- Assess trends in cardiac device implantations (pacemaker, AICD, CRT-P, CRT-D) in the U.S. from 1997-2004.
- Evaluate perioperative outcomes, patient characteristics, and hospital factors associated with these implantations.
Main Methods:
- Utilized Healthcare Cost and Utilization Project Nationwide Inpatient Sample data (1997-2004).
- Identified patients receiving pacemakers (PM), automatic cardioverter/defibrillators (AICD), cardiac resynchronization therapy pacemakers (CRT-P), or defibrillators (CRT-D) using ICD-9-CM codes.
- Analyzed length of stay, charges, in-hospital mortality, and complication rates.
Main Results:
- Implantations of AICDs and PMs increased by 60% and 19% respectively by 2004.
- Cardiac resynchronization therapy devices (CRT-D, CRT-P) saw rapid adoption post-2001.
- Length of stay decreased significantly (e.g., AICD halved), while charges nearly doubled.
- In-hospital mortality and complication rates showed slight fluctuations, primarily linked to older age, comorbidities, and emergency admissions.
Conclusions:
- Cardiac device implantations steadily increased between 1997 and 2004.
- Significant reductions in length of stay were observed, accompanied by substantial increases in healthcare charges.
- In-hospital adverse outcomes were mainly associated with patient frailty, not hospital volume.
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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