Variation in Regional Implantation Patterns of Cardiac Implantable Electronic Device in Switzerland

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2022 Feb 16

PMID 35171922

Authors

Lucy Bolt

Maria M Wertli

Alan G Haynes

Nicolas Rodondi

Arnaud Chiolero

Radoslaw Panczak

Drahomir Aujesky

Affiliations

Soon will be listed here.

Abstract

Introduction: There is a substantial geographical variation in the rates of pacemaker (PM), implantable cardioverter defibrillator (ICD), and cardiac resynchronization therapy (CRT) device implantation across European countries. We assessed the extent of regional variation and potential determinants of such variation.

Methods: We conducted a population-based analysis using discharge data for PM/ICD/CRT implantations from all Swiss acute care hospitals during 2013-2016. We derived hospital service areas (HSA) by analyzing patient flows. We calculated age- and sex-standardized rates and quantified variation using the extremal quotient (EQ) and the systemic component of variation (SCV). We estimated the reduction in variance of crude implantation rates across HSAs using multilevel regression models, with incremental adjustment for age and sex, language, socioeconomic factors, population health, diabetes mellitus, and the density of cardiologists on the HSA level.

Results: We analyzed implantations of 8129 PM, 1461 ICD, and 1411 CRT from 25 Swiss HSAs. The mean age- and sex-standardized implantation rate was 29 (range 8-57) per 100,000 persons for PM, 5 (1-9) for ICD, and 5 (2-8) for CRT. There was a very high variation in PM (EQ 7.0; SCV 12.6) and ICD (EQ 7.2; SCV 11.3) and a high variation in CRT implantation rates (EQ 3.9; SCV 7.1) across HSAs. Adjustments for age and sex, language, socioeconomic factors, population health, diabetes mellitus, and density of cardiologists explained 94% of the variance in ICD and 87.5% of the variance in CRT implantation rates, but only 36.3% of the variance in PM implantation rates. Women had substantially lower PM/ICD/CRT implantation rates than men.

Conclusion: Switzerland has a very high regional variation in PM/ICD implantation and a high variation in CRT implantation rates. Women had substantially lower implantation rates than men. A large share of the variation in PM procedure rates remained unexplained which might reflect variations in physicians' preferences and practices.

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References

Berlin C, Juni P, Endrich O, Zwahlen M . Revascularization Treatment of Emergency Patients with Acute ST-Segment Elevation Myocardial Infarction in Switzerland: Results from a Nationwide, Cross-Sectional Study in Switzerland for 2010-2011. PLoS One. 2016; 11(4):e0153326. PMC: 4831744. DOI: 10.1371/journal.pone.0153326. View

Bleumink G, Knetsch A, Sturkenboom M, Straus S, Hofman A, Deckers J . Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure The Rotterdam Study. Eur Heart J. 2004; 25(18):1614-9. DOI: 10.1016/j.ehj.2004.06.038. View

Russo A, Daugherty S, Masoudi F, Wang Y, Curtis J, Lampert R . Gender and outcomes after primary prevention implantable cardioverter-defibrillator implantation: Findings from the National Cardiovascular Data Registry (NCDR). Am Heart J. 2015; 170(2):330-8. PMC: 4768728. DOI: 10.1016/j.ahj.2015.02.025. View

Priori S, Blomstrom-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J . 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the.... Eur Heart J. 2015; 36(41):2793-2867. DOI: 10.1093/eurheartj/ehv316. View

Jensen P, Gronroos N, Chen L, Folsom A, deFilippi C, Heckbert S . Incidence of and risk factors for sick sinus syndrome in the general population. J Am Coll Cardiol. 2014; 64(6):531-8. PMC: 4139053. DOI: 10.1016/j.jacc.2014.03.056. View

Bopp M, Spoerri A, Zwahlen M, Gutzwiller F, Paccaud F, Braun-Fahrlander C . Cohort Profile: the Swiss National Cohort--a longitudinal study of 6.8 million people. Int J Epidemiol. 2008; 38(2):379-84. DOI: 10.1093/ije/dyn042. View

Banks H, Torbica A, Valzania C, Varabyova Y, Rupel V, Taylor R . Five year trends (2008-2012) in cardiac implantable electrical device utilization in five European nations: a case study in cross-country comparisons using administrative databases. Europace. 2017; 20(4):643-653. DOI: 10.1093/europace/eux123. View

Breslow N, Day N . Indirect standardization and multiplicative models for rates, with reference to the age adjustment of cancer incidence and relative frequency data. J Chronic Dis. 1975; 28(5-6):289-303. DOI: 10.1016/0021-9681(75)90010-7. View

Sutherland K, Levesque J . Unwarranted clinical variation in health care: Definitions and proposal of an analytic framework. J Eval Clin Pract. 2019; 26(3):687-696. PMC: 7317701. DOI: 10.1111/jep.13181. View

10.

Borne R, Randolph T, Wang Y, Curtis J, Peterson P, Masoudi F . Analysis of Temporal Trends and Variation in the Use of Defibrillation Testing in Contemporary Practice. JAMA Netw Open. 2019; 2(10):e1913553. PMC: 6813586. DOI: 10.1001/jamanetworkopen.2019.13553. View

11.

Peterson P, Daugherty S, Wang Y, Vidaillet H, Heidenreich P, Curtis J . Gender differences in procedure-related adverse events in patients receiving implantable cardioverter-defibrillator therapy. Circulation. 2009; 119(8):1078-84. DOI: 10.1161/CIRCULATIONAHA.108.793463. View

12.

Mantwill S, Schulz P . Low health literacy and healthcare utilization among immigrants and non-immigrants in Switzerland. Patient Educ Couns. 2017; 100(11):2020-2027. DOI: 10.1016/j.pec.2017.05.023. View

13.

Bogle B, Ning H, Mehrotra S, Goldberger J, Lloyd-Jones D . Lifetime Risk for Sudden Cardiac Death in the Community. J Am Heart Assoc. 2016; 5(7). PMC: 5015355. DOI: 10.1161/JAHA.115.002398. View

14.

Frei A, Gellad W, Wertli M, Haynes A, Chiolero A, Rodondi N . Trends and regional variation in vertebroplasty and kyphoplasty in Switzerland: a population-based small area analysis. Osteoporos Int. 2021; 32(12):2515-2524. PMC: 8608764. DOI: 10.1007/s00198-021-06026-x. View

15.

Al-Khatib S, Hellkamp A, Hernandez A, Fonarow G, Thomas K, Al-Khalidi H . Trends in use of implantable cardioverter-defibrillator therapy among patients hospitalized for heart failure: have the previously observed sex and racial disparities changed over time?. Circulation. 2012; 125(9):1094-101. PMC: 3670671. DOI: 10.1161/CIRCULATIONAHA.111.066605. View

16.

Scheuter C, Wertli M, Haynes A, Panczak R, Chiolero A, Perrier A . Unwarranted regional variation in vertebroplasty and kyphoplasty in Switzerland: A population-based small area variation analysis. PLoS One. 2018; 13(12):e0208578. PMC: 6287855. DOI: 10.1371/journal.pone.0208578. View

17.

Fernandez Lozano I, Osca Asensi J, Alzueta Rodriguez J . Spanish Implantable Cardioverter-defibrillator Registry. 15th Official Report of the Spanish Society of Cardiology Electrophysiology and Arrhythmias Section (2018). Rev Esp Cardiol (Engl Ed). 2019; 72(12):1054-1064. DOI: 10.1016/j.rec.2019.10.002. View

18.

Merkely B, Roka A, Kutyifa V, Boersma L, Leenhardt A, Lubinski A . Tracing the European course of cardiac resynchronization therapy from 2006 to 2008. Europace. 2010; 12(5):692-701. DOI: 10.1093/europace/euq041. View

19.

McPherson K, WENNBERG J, Hovind O, Clifford P . Small-area variations in the use of common surgical procedures: an international comparison of New England, England, and Norway. N Engl J Med. 1982; 307(21):1310-4. DOI: 10.1056/NEJM198211183072104. View

20.

Radovanovic D, Seifert B, Roffi M, Urban P, Rickli H, Pedrazzini G . Gender differences in the decrease of in-hospital mortality in patients with acute myocardial infarction during the last 20 years in Switzerland. Open Heart. 2017; 4(2):e000689. PMC: 5687526. DOI: 10.1136/openhrt-2017-000689. View