Agency News and Notes

Implantation of cardiac devices has increased 145 percent since 1997

Patients with irregular heart rhythms are receiving cardiac devices to regulate their hearts more often than in the past, a new study finds. Researchers from the Agency for Healthcare Research and Quality found a 145 percent increase from 1997 to 2004 in implantations of traditional pacemakers and automatic internal cardioverter defibrillators (AICD), along with the newer cardiac resynchronization therapy pacemakers (CRT-P) and defibrillators (CRT-D) that were approved by the U.S. Food and Drug Administration in 2001. All of these devices provide their recipients a more coordinated and effective heartbeat.

Using Healthcare Cost and Utilization (HCUP) data, Chunliu Zhan, M.D., Ph.D., William B. Baine, M.D., Artyom Sedrakyan, M.D., Ph.D., and Claudia Steiner, M.P.H., M.D., found that in 2004, about 33,000 CRT-Ds, 7,000 CRT-Ps, 67,000 AICDs, and 179,000 pacemakers were implanted in the United States. >Most patients were elderly and white and had multiple chronic conditions. Most CRT and AICD implantations were performed at large teaching hospitals, while nonteaching, low-volume hospitals (fewer than 100 implantations a year) tended to choose pacemakers for their patients.

While hospital stays declined from 9.19 days to 5 days for AICD implantation from 1997 to 2004, the average cost for the procedure jumped from nearly $67,000 to almost $115,000. The authors suggest the profitability and widespread use of implantation calls for more research into the devices' proper application.

The research team also showed that HCUP data were an efficient, reliable source to track cardiac device use, patient and hospital characteristics, and risks and outcomes.

See "Cardiac device implantation in the United States from 1997 through 2004: A population-based analysis," by Drs. Zhan, Baine, Sedrakyan, and Steiner in the Journal of General Internal Medicine 23(Supplement 1), pp. 13-19, 2007.

Reprints (AHRQ Publication No. 08-R037) are available from the AHRQ Publications Clearinghouse.

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