Trends in permanent pacemaker implantation in the United States from 1993 to 2009: increasing complexity of patients and procedures.

Authors

Arnold J Greenspon, Thomas Jefferson UniversityFollow
Jasmine D Patel, Drexel UniversityFollow
Edmund Lau, Drexel UniversityFollow
Jorge A Ochoa, Exponent, PhiladelphiaFollow
Daniel R Frisch, Thomas Jefferson UniversityFollow
Reginald T Ho, Thomas Jefferson UniversityFollow
Behzad B. Pavri, Thomas Jefferson UniversityFollow
Steven M Kurtz, Drexel UniversityFollow

Document Type

Article

Publication Date

10-16-2012

Comments

This article has been peer reviewed. It is the authors' final version prior to publication in Journal of the American College of Cardiology

Volume 60, Issue 16, October 2012, Pages 1540-1545.

The published version is available at DOI:10.1016/j.jacc.2012.07.017. Copyright © Elsevier Inc.

Abstract

OBJECTIVES: This study sought to define contemporary trends in permanent pacemaker use by analyzing a large national database.

BACKGROUND: The Medicare National Coverage Determination for permanent pacemaker, which emphasized single-chamber pacing, has not changed significantly since 1985. We sought to define contemporary trends in permanent pacemaker use by analyzing a large national database.

METHODS: We queried the Nationwide Inpatient Sample to identify permanent pacemaker implants between 1993 and 2009 using the International Classification of Diseases-Ninth Revision-Clinical Modification procedure codes for dual-chamber (DDD), single-ventricular (VVI), single-atrial (AAI), or biventricular (BiV) devices. Annual permanent pacemaker implantation rates and patient demographics were analyzed.

RESULTS: Between 1993 and 2009, 2.9 million patients received permanent pacemakers in the United States. Overall use increased by 55.6%. By 2009, DDD use increased from 62% to 82% (p < 0.001), whereas single-chamber ventricular pacemaker use fell from 36% to 14% (p = 0.01). Use of DDD devices was higher in urban, nonteaching hospitals (79%) compared with urban teaching hospitals (76%) and rural hospitals (72%). Patients with private insurance (83%) more commonly received DDD devices than Medicaid (79%) or Medicare (75%) recipients (p < 0.001). Patient age and Charlson comorbidity index increased over time. Hospital charges ($2011) increased 45.3%, driven by the increased cost of DDD devices.

CONCLUSIONS: There is a steady growth in the use of permanent pacemakers in the United States. Although DDD device use is increasing, whereas single-chamber ventricular pacemaker use is decreasing. Patients are becoming older and have more medical comorbidities. These trends have important health care policy implications.

Recommended Citation

Greenspon, Arnold J; Patel, Jasmine D; Lau, Edmund; Ochoa, Jorge A; Frisch, Daniel R; Ho, Reginald T; Pavri, Behzad B.; and Kurtz, Steven M, "Trends in permanent pacemaker implantation in the United States from 1993 to 2009: increasing complexity of patients and procedures." (2012). Division of Cardiology Faculty Papers. Paper 18.
https://jdc.jefferson.edu/cardiologyfp/18

PubMed ID

22999727