Differences between Korea and Japan in Physician Decision Making Regarding Permanent Pacemaker Implantation

Area of Science:

• Cardiology
• Medical Device Therapy
• Clinical Decision-Making

Background:

• Significant disparities exist in the number of permanent pacemakers (PPMs) implanted between Japan and Korea.
• Understanding the underlying decision-making processes is crucial for addressing these differences.

Purpose of the Study:

• To investigate and compare the decision-making processes of Korean and Japanese physicians regarding PPM implantation.
• To identify factors influencing the variation in PPM implantation rates between the two countries.

Main Methods:

• A survey was conducted among Korean and Japanese cardiologists.
• Participants evaluated 15 clinical scenarios based on 2008 AHA/ACC/HRS guidelines.
• Physicians indicated their decision for or against PPM implantation on a 5-point scale.

Main Results:

• No significant difference in PPM implantation decisions was observed for Class I indications.
• Japanese physicians were significantly more likely to recommend PPM implantation in Class IIa, IIb, and Class III scenarios compared to Korean physicians.
• These trends persisted across different cardiac conditions like sinus node dysfunction and conduction abnormalities.

Conclusions:

• Korean physicians demonstrate a more conservative approach to PPM implantation compared to their Japanese counterparts.
• This difference in clinical judgment likely contributes to the lower PPM implantation rates observed in Korea.
• Further research may explore patient-specific factors and guideline adherence in PPM decision-making.