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Takase B, Ikeda T, Shimizu W, Abe H, Aiba T, Chinushi M, Koba S, Kusano K, Niwano S, Takahashi N, Takatsuki S, Tanno K, Watanabe E, Yoshioka K, Amino M, Fujino T, Iwasaki Y, Kohno R, Kinoshita T, Kurita Y, Masaki N, Murata H, Shinohara T, Yada H, Yodogawa K, Kimura T, Kurita T, Nogami A, Sumitomo N. JCS/JHRS 2022 Guideline on Diagnosis and Risk Assessment of Arrhythmia. J Arrhythm 2024; 40:655-752. [PMID: 39139890 PMCID: PMC11317726 DOI: 10.1002/joa3.13052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 08/15/2024] Open
Affiliation(s)
| | - Takanori Ikeda
- Department of Cardiovascular MedicineToho University Faculty of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular MedicineNippon Medical School
| | - Haruhiko Abe
- Department of Heart Rhythm ManagementUniversity of Occupational and Environmental HealthJapan
| | - Takeshi Aiba
- Department of Clinical Laboratory Medicine and GeneticsNational Cerebral and Cardiovascular Center
| | | | - Shinji Koba
- Division of Cardiology, Department of MedicineShowa University School of Medicine
| | - Kengo Kusano
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular Center
| | - Shinichi Niwano
- Department of Cardiovascular MedicineKitasato University School of Medicine
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita University
| | | | - Kaoru Tanno
- Cardiovascular Center, Cardiology DivisionShowa University Koto‐Toyosu Hospital
| | - Eiichi Watanabe
- Division of Cardiology, Department of Internal MedicineFujita Health University Bantane Hospital
| | | | - Mari Amino
- Department of CardiologyTokai University School of Medicine
| | - Tadashi Fujino
- Department of Cardiovascular MedicineToho University Faculty of Medicine
| | - Yu‐ki Iwasaki
- Department of Cardiovascular MedicineNippon Medical School
| | - Ritsuko Kohno
- Department of Heart Rhythm ManagementUniversity of Occupational and Environmental HealthJapan
| | - Toshio Kinoshita
- Department of Cardiovascular MedicineToho University Faculty of Medicine
| | - Yasuo Kurita
- Cardiovascular Center, Mita HospitalInternational University of Health and Welfare
| | - Nobuyuki Masaki
- Department of Intensive Care MedicineNational Defense Medical College
| | | | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita University
| | - Hirotaka Yada
- Department of CardiologyInternational University of Health and Welfare Mita Hospital
| | - Kenji Yodogawa
- Department of Cardiovascular MedicineNippon Medical School
| | - Takeshi Kimura
- Cardiovascular MedicineKyoto University Graduate School of Medicine
| | | | - Akihiko Nogami
- Department of Cardiology, Faculty of MedicineUniversity of Tsukuba
| | - Naokata Sumitomo
- Department of Pediatric CardiologySaitama Medical University International Medical Center
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Vaidya VR, Asirvatham R, Kowlgi GN, Dai MY, Cochuyt JJ, Hodge DO, Deshmukh AJ, Cha YM. Trends in Cardiovascular Implantable Electronic Device Insertion Between 1988 and 2018 in Olmsted County. JACC Clin Electrophysiol 2022; 8:88-100. [PMID: 34454890 PMCID: PMC9339254 DOI: 10.1016/j.jacep.2021.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study sought to describe trends in cardiovascular implantable electronic device (CIED) insertion over the past 3 decades in Olmsted County. BACKGROUND Trends in CIED insertion in the United States have not been extensively studied. METHODS The Rochester Epidemiology Project is a medical records linkage system comprising the records of all residents of Olmsted County from 1966 to the present. CIED insertion between 1988 and 2018 was determined using International Classification of Diseases-Ninth Revision, International Classification of Diseases-10th Revision, and Current Procedural Terminology codes. Age- and sex-adjusted incidence rates, adjusted to the 2010 US White population, were calculated. Trends in incidence over time, across age groups, and between sex are estimated using Poisson regression models. RESULTS The age- and sex-adjusted incidence of device implants for the study period were as follows: overall CIED: 82.4 (95% CI: 79.2-85.6); permanent pacemaker (PPM): 62.9 (95% CI: 60.0-65.7); implantable cardioverter-defibrillator (ICD): 14.0 (95% CI: 12.6-15.3); and cardiac resynchronization therapy (CRT): 5.6 (95% CI: 4.7-6.4) per 100,000 per year. The overall incidence of CIED insertion increased between 1988 to 1993 and 2000 to 2005 and then decreased between 2000 to 2005 and 2012 to 218 (P < 0.0001). PPM and ICD insertion incidence followed these trends, whereas the incidence of CRT insertion increased between 2000 to 2005 and 2012 to 2018. CIED insertion incidence increased with age (P < 0.0001). CIED insertion incidence was greater in men (116.3 vs 57.3 per 100,000 per year in men vs women; P < 0.0001). The overall survival of CRT recipients improved (P = 0.0044). CONCLUSIONS The incidence values for PPM and ICD implants are decreasing, while the incidence of CRT implants is increasing. CIEDs are increasingly inserted in the elderly, men, and patients with higher comorbidities.
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Affiliation(s)
- Vaibhav R. Vaidya
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Roshini Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Gurukripa N. Kowlgi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Ming-Yan Dai
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA,Cardiovascular Research Institute and Department of Cardiology, Renmin Hospital of Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Jordan J. Cochuyt
- Department of Quantitative Heath Sciences, Mayo Clinic, Jacksonville, FL 32224, USA
| | - David O. Hodge
- Department of Quantitative Heath Sciences, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Yong Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Patel S, Jamoor K, Khan A, Maskoun W. Late onset complete heart block after transcatheter aortic valve replacement treated with permanent His-bundle pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 44:194-198. [PMID: 32940376 DOI: 10.1111/pace.14074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 09/02/2020] [Accepted: 09/13/2020] [Indexed: 12/29/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is a rapidly growing procedure. Conduction disease post-TAVR is frequent and routinely monitored for periprocedurally. Permanent pacemaker placement is relatively common and usually associated with worse outcomes post-TAVR. We report a case of very late presenting complete heart block post-TAVR treated with His-bundle pacing. Our case underscores the need for larger studies to further evaluate the utility of long-term cardiac monitoring post-TAVR and outcomes of His-bundle pacing in this population.
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Affiliation(s)
- Sati Patel
- Division of Cardiovascular Disease, Henry Ford Health System, Detroit, Michigan
| | - Khaled Jamoor
- Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan
| | - Arfaat Khan
- Division of Cardiovascular Disease, Henry Ford Health System, Detroit, Michigan
| | - Waddah Maskoun
- Division of Cardiovascular Disease, Henry Ford Health System, Detroit, Michigan
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Atrial involvement and progression of sinus node dysfunction in non-senile patients: evidences from electroanatomic mapping and long-term follow-up. J Interv Card Electrophysiol 2020; 60:365-373. [PMID: 32318962 DOI: 10.1007/s10840-020-00735-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 03/23/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Sinus node inability or conduction disorders of its surrounding atrial myocardium cause sinus node dysfunction (SND). This study aimed to characterize right atrium (RA) substrates and long-term atrial lead performance after pacemaker implantation in non-senile SND patients. METHODS Eighteen SND patients (53.3 ± 9.6 years) controlled by 18 age-matched supraventricular tachycardia patients were consecutively enrolled. The P-wave amplitude (PWA) and P-wave duration (PWD) were measured on surface electrocardiography. Electroanatomic mapping was conducted to assess the bipolar voltage, complex signals, volume, and activation time of RA. Pacemaker implantation was performed in SND patients after mapping. RESULTS Compared with controls, SND patients showed significant PWA reduction (0.13 ± 0.02 vs. 0.16 ± 0.04 mV, p = 0.017) and PWD prolongation (120.8 ± 15.2 vs. 105.2 ± 8.6 ms, p = 0.001). The RA endocardial voltage was lower (1.56 ± 0.78 vs. 2.57 ± 0.55 mV, p < 0.001) and activation time was longer (112.1 ± 14.9 vs. 90.8 ± 12.4 ms, p < 0.001) in the study group. Atrial lead was anchored at the lower atrial septum in one patient and failed in another due to extensive atrial scarring. During a median follow-up of 86 (57-88) months, one patient lost atrial capturing, and overall atrial sensing was significantly decreased (2.44 ± 1.16 vs. 1.87 ± 1.01 mV, p = 0.003). CONCLUSIONS Atrial involvement was proved and the process was progressive in non-senile SND patients, as demonstrated by diffused RA lower voltage, slower conduction, and the decrease of the atrial lead sensing.
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Roncero C, Mardigyan V, Service E, Singerman J, Whittaker KC, Friedman M, Chertkow H. Investigation into the effect of transcranial direct current stimulation on cardiac pacemakers. Brain Stimul 2019; 13:89-95. [PMID: 31481297 DOI: 10.1016/j.brs.2019.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/10/2019] [Accepted: 08/16/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Studies investigating the therapeutic applications of transcranial direct current stimulation (tDCS) in the treatment of age-related neurodegenerative disease have been promising. However, exclusion criteria for these studies invariably disqualify patients implanted with internal cardiac pacemakers, citing safety concerns. Because the majority of cardiac pacemaker implantees are over 65, this criterion may limit candidacy for tDCS based research and/or treatment of age-related neurodegenerative disease. OBJECTIVE/HYPOTHESIS We will test the hypothesis that tDCS impacts pacemaker function. Strong electrical potentials, such as those generated by external defibrillators (∼500 V, ∼10 A), are known to occasionally damage pacemaker circuitry and software, but it seems unlikely tDCS would damage a pacemaker because it involves about 1/200th the energy (∼12 V, ∼2 mA) of an external defibrillator. METHODS We delivered tDCS to seven participants (ages 70-92) with bipolar non-dependent pacemakers and subsequently collected data from the internal memory of the pacemakers to assess the tDCS signal detection, as well as alterations in mode switches, impedance levels, and pacing. Subsequently, similar assessments were carried out in participants who were pacemaker-dependent (ages 89-91). RESULTS After a review of the recordings, it was found that tDCS had no impact on the non-dependant, as well as the dependent, pacemakers. There were zero mode switches nor any impact on impedance levels. CONCLUSION Results in this small series of cases found no evidence that tDCS interferes with the function of the pacemakers and suggests tDCS can be delivered to patients equipped with a cardiac pacemaker. Further studies are needed to generalize these results to other pacemakers.
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Affiliation(s)
- Carlos Roncero
- Rotman Research Institute, Baycrest Health Science, Toronto, Canada; Lady Davis Institute, Jewish General Hospital, McGill University, 3755 Chemin de la cote Sainte-Catherine, H3T 1E2, Montreal, Quebec, Canada.
| | - Vartan Mardigyan
- Dept. of Cardiology, Jewish General Hospital, 3755 Chemin de la cote Sainte-Catherine, H3T 1E2, Montreal, Quebec, Canada.
| | - Erik Service
- Lady Davis Institute, Jewish General Hospital, McGill University, 3755 Chemin de la cote Sainte-Catherine, H3T 1E2, Montreal, Quebec, Canada.
| | - Julia Singerman
- Lady Davis Institute, Jewish General Hospital, McGill University, 3755 Chemin de la cote Sainte-Catherine, H3T 1E2, Montreal, Quebec, Canada.
| | - Kayla Chennelle Whittaker
- Lady Davis Institute, Jewish General Hospital, McGill University, 3755 Chemin de la cote Sainte-Catherine, H3T 1E2, Montreal, Quebec, Canada.
| | - Michal Friedman
- Lady Davis Institute, Jewish General Hospital, McGill University, 3755 Chemin de la cote Sainte-Catherine, H3T 1E2, Montreal, Quebec, Canada.
| | - Howard Chertkow
- Rotman Research Institute, Baycrest Health Science, Toronto, Canada; Lady Davis Institute, Jewish General Hospital, McGill University, 3755 Chemin de la cote Sainte-Catherine, H3T 1E2, Montreal, Quebec, Canada.
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay. Heart Rhythm 2019; 16:e128-e226. [DOI: 10.1016/j.hrthm.2018.10.037] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Indexed: 12/13/2022]
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2019; 140:e382-e482. [DOI: 10.1161/cir.0000000000000628] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | | | - Kenneth A. Ellenbogen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- ACC/AHA Representative
| | - Michael R. Gold
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- HRS Representative
| | | | | | - José A. Joglar
- ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | | | | | | | | | | | | | - Cara N. Pellegrini
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- HRS Representative
- Dr. Pellegrini contributed to this article in her personal capacity. The views expressed are her own and do not necessarily represent the views of the US Department of Veterans Affairs or the US government
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay. J Am Coll Cardiol 2019; 74:e51-e156. [DOI: 10.1016/j.jacc.2018.10.044] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Netzer NC, Ancoli-Israel S, Bliwise DL, Fulda S, Roffe C, Almeida F, Onen H, Onen F, Raschke F, Martinez Garcia MA, Frohnhofen H. Principles of practice parameters for the treatment of sleep disordered breathing in the elderly and frail elderly: the consensus of the International Geriatric Sleep Medicine Task Force. Eur Respir J 2016; 48:992-1018. [DOI: 10.1183/13993003.01975-2015] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 05/03/2016] [Indexed: 12/11/2022]
Abstract
Sleep disordered breathing (SDB) is a leading cause of morbidity worldwide. Its prevalence increases with age. Due to the demographic changes in industrial societies, pulmonologists and sleep physicians are confronted with a rapidly growing number of elderly SDB patients. For many physicians, it remains unclear how current guidelines for SDB management apply to elderly and frail elderly patients. The goal of this consensus statement is to provide guidance based on published evidence for SDB treatment in this specific patient group.Clinicians and researchers with expertise in geriatric sleep medicine representing several countries were invited to participate in a task force. A literature search of PubMed from the past 12 years and a systematic review of evidence of studies deemed relevant was performed.Recommendations for treatment management of elderly and frail elderly SDB patients based on published evidence were formulatedviadiscussion and consensus.In the last 12 years, there have been surprisingly few studies examining treatment of SDB in older adults and even fewer in frail older adults. Studies that have been conducted on the management of SDB in the older patient population were rarely stratified for age. Studies in SDB treatment that did include age stratification mainly focused on middle-aged and younger patient groups. Based on the evidence that is available, this consensus statement highlights the treatment forms that can be recommended for elderly SDB patients and encourages treatment of SDB in this large patient group.
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Bradshaw PJ, Stobie P, Einarsdóttir K, Briffa TG, Hobbs MST. Using quality indicators to compare outcomes of permanent cardiac pacemaker implantation among publicly and privately funded patients. Intern Med J 2015; 45:813-20. [PMID: 25851227 DOI: 10.1111/imj.12762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 03/30/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Funding source/insurance status has been associated with disparity in the management and outcomes of cardiovascular disease, with poorer outcomes among disadvantaged groups. AIM Using proposed quality indicators for permanent pacemaker (PPM) implantation and administrative data, this study aimed to determine whether quality indicator-based outcomes of PPM implantation were comparable for publicly and privately funded patients within Australia's two-tier health system. METHODS A population-based cohort study of adults implanted with a PPM between 1995 and 2009 in Western Australia. The association of funding outcomes derived from linked administrative data was tested in multivariate logistic regression models. RESULTS There were 9748 PPMs implanted, 48% being among privately funded patients. The mean age was 75 years for both public and private patients. Private patients had better health status (fewer with cardiac conditions and lower non-cardiac comorbidity scores), were less likely to be an emergency admission (33% vs 60%, P < 0.001) and more likely to have dual- or triple-chamber pacing. Mean length of stay was significantly greater for private patients (4.3 (standard deviation 6.3) vs 5.1 (6.8) days <0.001), related to longer elective admissions. Crude mortality was lower for private patients in-hospital (0.7 vs 1.3%), 30-day post-procedure (1.3 vs 2.1%) and at 1 year (7.3 vs 9.5%). Emergency admission, comorbidity and other demographic and clinical factors, not funding source, were significant predictors of these outcomes. CONCLUSIONS There was no difference between publicly and privately funded patients in study outcomes, after adjustment for demographic and clinical factors. The exception was longer hospital stay for elective PPM among privately funded patients.
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Affiliation(s)
- P J Bradshaw
- Cardiovascular Research Group, The University of Western Australia, Perth, Western Australia, Australia
| | - P Stobie
- School of Medicine and Pharmacology, Sir Charles Gairdner Hospital and The University of Western Australia, Perth, Western Australia, Australia
| | - K Einarsdóttir
- Centre for Health Services Research, School of Population Health, The University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - T G Briffa
- Cardiovascular Research Group, The University of Western Australia, Perth, Western Australia, Australia
| | - M S T Hobbs
- Cardiovascular Research Group, The University of Western Australia, Perth, Western Australia, Australia
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Sloan FA, George LK, Hu L. Emergency room and inpatient use after cardiac pacemaker implantation. Am J Cardiol 2013; 111:563-8. [PMID: 23211359 DOI: 10.1016/j.amjcard.2012.10.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 10/29/2012] [Accepted: 10/29/2012] [Indexed: 11/24/2022]
Abstract
Although studies have demonstrated health benefits, there is limited evidence on utilization and cost changes associated with cardiac pacemaker implantation from national community samples. The aim of this study was to quantify changes in emergency room (ER) and hospital inpatient use and in Medicare payments per beneficiary/year after pacemaker implantation. Outcomes for pacemaker recipients after and before implantation and between pacemaker recipients and controls were compared using propensity score matching. Data came from Health and Retirement Study interviews merged with Medicare claims. Sample subjects were aged ≥68 years with diagnosed conduction disorders or cardiac dysrhythmias in the previous 3 years. Outcome measures were (1) ER visits, inpatient admissions and days, and Medicare payments for ER and inpatient care in the after period for the pacemaker versus control groups, defined per beneficiary/year, (2) difference in differences in the same 5 outcome variables, and (3) binary variables for whether or not utilization or payments were lower in the after versus before periods for the pacemaker versus control groups. In conclusion, most pacemaker recipients improved, as measured by reductions in use and payments in the after versus before period, and there were reductions in ER visits and hospital admissions for conditions commonly leading to pacemaker implantation.
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LOGANI SACHIN, GOTTLIEB MAIA, VERDINO RALPHJ, BAMAN TIMIRS, EAGLE KIMA, KIRKPATRICK JAMESN. Recovery of Pacemakers and Defibrillators for Analysis and Device Advance Directives: Electrophysiologists’ Perspectives. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:659-65. [DOI: 10.1111/j.1540-8159.2011.03032.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Zhan C, Baine WB, Sedrakyan A, Steiner C. Cardiac device implantation in the United States from 1997 through 2004: a population-based analysis. J Gen Intern Med 2008; 23 Suppl 1:13-9. [PMID: 18095038 PMCID: PMC2359586 DOI: 10.1007/s11606-007-0392-0] [Citation(s) in RCA: 165] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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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Affiliation(s)
- Chunliu Zhan
- Center for Outcomes and Evidence, Agency for Healthcare Research and Quality, Rockville, MD, USA.
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Birnie D, Williams K, Guo A, Mielniczuk L, Davis D, Lemery R, Green M, Gollob M, Tang A. Reasons for escalating pacemaker implants. Am J Cardiol 2006; 98:93-7. [PMID: 16784928 DOI: 10.1016/j.amjcard.2006.01.069] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Revised: 01/11/2006] [Accepted: 01/11/2006] [Indexed: 11/15/2022]
Abstract
Surveys of pacing practice have shown a steady increase in pacemaker implantation rates in the past 15 years, despite no major changes in United States guidelines for permanent pacing. There are no data to explain why this is occurring. In this study, records were extracted from the National Hospital Discharge Survey to investigate this. There were 3 major findings. First, age-adjusted implantation rates increased progressively over the study period from 370 per million in 1990 to 612 per million in 2002. Second, it was found that the escalating implantation rate is attributable to increasing implantation for isolated sinus node dysfunction (SND). Implantation for SND increased significantly over the study period (by 102%), whereas implantation for all other indications did not. The increasing implantation for SND is due primarily to the increasing prevalence of SND, with a lesser increase in implantation rate relative to prevalence rate. The third major finding of this study is that there has been a progressive relative and absolute increase in the dual-chamber implantation rate. In 2002, 82.8% of all initial pacemaker implantations were dual-chamber devices. Furthermore, the National Hospital Discharge Survey data indicate that the major randomized pacing trials seem to have had no impact on pacing practice in the United States. In conclusion, age-adjusted implantation rates increased progressively over the study period. This escalating implantation rate is primarily attributable to increasing implantation for SND.
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Affiliation(s)
- David Birnie
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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Abstract
Sleep apnea has been increasingly recognized for its prevalence and its impact on cardiovascular health. The disorder has considerable impact on cardiovascular disease states, particularly congestive heart failure. Implantable cardiac pacing devices may have a role in both the diagnosis and therapy of sleep apnea, which may be of particular importance given the seemingly wide coprevalence of cardiac disorders and sleep apnea.
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Affiliation(s)
- Alaa A Shalaby
- University of Pittsburgh, Division of Cardiology, Pittsburgh VA Healthcare System, Pittsburgh, PA 15240, USA.
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Brown DW, Croft JB, Giles WH, Anda RF, Mensah GA. Epidemiology of pacemaker procedures among Medicare enrollees in 1990, 1995, and 2000. Am J Cardiol 2005; 95:409-11. [PMID: 15670557 DOI: 10.1016/j.amjcard.2004.09.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2004] [Revised: 09/20/2004] [Accepted: 09/20/2004] [Indexed: 10/25/2022]
Abstract
Using Medicare hospital claims records and beneficiary enrollment data, the investigators describe the epidemiology of inpatient pacemaker procedures (International Classification of Diseases, Ninth Revision, Clinical Modification codes 37.80 to 37.89) in Medicare enrollees. From 1990 to 2000, the age-standardized inpatient pacemaker procedure prevalence (per 100,000 enrollees) increased from 325.4 to 504.4 in all Medicare beneficiaries. The prevalence increased significantly with age; was less for women than for men; and was less for blacks, Hispanics, and Asians than for whites.
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Affiliation(s)
- David W Brown
- Emerging Investigations and Analytic Methods Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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17
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Abstract
BACKGROUND The consequences of war and medical discourse have historical connections to pacemaker technology. Understanding these consequences is important because war veterans, medicine and cardiac technology have a shared history that continues into the present. The incidence of Australian war veterans needing cardiac pacemakers has increased many-fold in recent years, due to advancing age. This need was recognized by the Australian Department of Veteran Affairs and a cardiac programme was established in the veteran hospital that was the setting for this study. AIM This paper reports on a study aimed at capturing the interest and sensitizing the practice of nurses involved in the care of war veterans and other health care consumers who have been diagnosed as requiring a cardiac pacemaker. The study sought to answer the question, 'How does the war veteran experience his body in relation to invasive cardiac technology?'. METHOD The research was guided by the principles of interpretive interactionism, and used unstructured interviews with eight male war veterans. The data were collected in 2000. FINDINGS Thematic and content analysis revealed five themes: emotional knowing; the medical encounter; belief in the myth of miracle; technological constraint; and the altered heart. The findings indicated that the human dimension was characterized by experiences of ambivalence, inner conflict, powerlessness and suffering. CONCLUSION Nursing is at the interface of science and patient care, and this study contributes to nursing knowledge by focusing on a previously unresearched topic, namely embodied interactions between war veterans and invasive cardiac pacemakers. Within a highly technical area such as cardiology, nurses can still work around the technology and keep patients as their primary focus, thus promoting quality care. A humanistic rather than a technological focus locates nurses between patients and cardiac technology. In this in-between location, nurses are not an extension of cardiac technology but a valuable source of information, education, and counselling.
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Affiliation(s)
- Carole C Anderson
- Faculty of Nursing and Health, Griffith University, Nathan, Queensland, Australia.
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18
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Abstract
CONTEXT Electronic medical devices (EMDs) with downloadable memories, such as implantable cardiac pacemakers, defibrillators, drug pumps, insulin pumps, and glucose monitors, are now an integral part of routine medical practice in the United States, and functional organ replacements, such as the artificial heart, pancreas, and retina, will most likely become commonplace in the near future. Often, EMDs end up in the hands of the pathologist as a surgical specimen or at autopsy. No established guidelines for systematic examination and reporting or comprehensive reviews of EMDs currently exist for the pathologist. OBJECTIVE To provide pathologists with a general overview of EMDs, including a brief history; epidemiology; essential technical aspects, indications, contraindications, and complications of selected devices; potential applications in pathology; relevant government regulations; and suggested examination and reporting guidelines. DATA SOURCES Articles indexed on PubMed of the National Library of Medicine, various medical and history of medicine textbooks, US Food and Drug Administration publications and product information, and specifications provided by device manufacturers. STUDY SELECTION Studies were selected on the basis of relevance to the study objectives. DATA EXTRACTION Descriptive data were selected by the author. DATA SYNTHESIS Suggested examination and reporting guidelines for EMDs received as surgical specimens and retrieved at autopsy. CONCLUSIONS Electronic medical devices received as surgical specimens and retrieved at autopsy are increasing in number and level of sophistication. They should be systematically examined and reported, should have electronic memories downloaded when indicated, will help pathologists answer more questions with greater certainty, and should become an integral part of the formal knowledge base, research focus, training, and practice of pathology.
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Affiliation(s)
- James B Weitzman
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA.
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19
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Bartsch C, Irnich W, Risse M, Junge M, Weiler G. Postmortem in situ diagnosis of pacemakers and electrodes to detect dysfunction. Leg Med (Tokyo) 2003; 5 Suppl 1:S397-400. [PMID: 12935642 DOI: 10.1016/s1344-6223(02)00171-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiac pacemakers usually are very reliable, but sometimes malfunctions of the system occur. We conceived and developed a method to judge the functionality of pacemaker systems in deceased patients. The idea was to verify the hypothesis that more dysfunctions of implanted pacemaker systems go undetected than are detected and corrected. With the aid of a pre-amplifier and a digital storage oscilloscope, pacemaker pulse signals are derived from the surface of the thorax. The derived pulse shape offers information on the functionality of pacemakers and electrodes. Additionally the lead impedance is measured with a test pacemaker and its corresponding hand-held programmer. Synchronization properties can also be assessed with an external test pacemaker. So far 262 pacemakers have been investigated yielding an anomaly rate of 15%, comprising life threatening to annoying malfunctions. These results emphasize the forensic relevance and give reason for a discussion about the natural cause of death in these cases.
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Affiliation(s)
- Christine Bartsch
- Department of Legal Medicine, Justus-Liebig-University School of Medicine, Frankfurter Strasse 58, 35392 Giessen, Germany.
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20
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Abstract
Medical device epidemiology is the study of the prevalence and incidence of use, effectiveness, and adverse events associated with medical devices in a population. The identification of large data sources with medical device data provides a large population for epidemiologic studies. Two challenges in medical device epidemiology are the ability to find data on the specific device and the exposure of a patient to that device. This paper identifies data sources both from the govenment and from the private sector that can be used for epidemiologic studies of medical devices and, to a limited degree, studies of medical devices in women. Each source provides data for different types of devices and in differing specificity. The paper also discusses briefly the strengths and weaknesses of each data source. More data sources are needed to enhance the study of medical device epidemiology. Additional efforts and focus are needed to enhance the ability to study medical devices in women.
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Affiliation(s)
- Mary E Torrence
- Epidemiology Branch, Office of Surveillance and Biometrics, Center for Devices and Radiological Health, Food and Drug Administration, Rockville MD 20250-2220, USA.
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21
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Hutchinson AB, Fergusson D, Graham ID, Laupacis A, Herrin J, Hillyer CD. Utilization of technologies to reduce allogeneic blood transfusion in the United States. Transfus Med 2001; 11:79-85. [PMID: 11299024 DOI: 10.1046/j.1365-3148.2001.00290.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Concern over safety of the blood supply has led to the use of technologies to reduce allogeneic blood transfusion. The objective of this research was to determine the utilization of these technologies in the United States. We evaluated the following techniques: preoperative autologous donation (PAD), cell salvage (CS) and acute normovolemic haemodilution (ANH); and the following pharmaceuticals: aprotinin (APR), epsilon-aminocaproic acid (EACA), tranexamic acid (TXA), desmopressin (DDAVP) and recombinant human erythropoietin (EPO). In 1997, we conducted a cross-sectional mail survey of service chiefs at 1000 US hospitals randomly selected and stratified by status as a provider of open-heart surgery, geographical location and hospital bed size. Sixty-nine per cent (690) of hospitals responded to at least one of the four surveys sent to each hospital. Hospitals reported use of techniques more than pharmaceuticals (P < 0.001); PAD (83%, n = 206) and CS (82% n = 420) were used most frequently. Lack of familiarity was the most common reason cited for infrequent use of pharmaceuticals. Organizational characteristics (e.g. provision of open-heart surgery, size, geographical location, teaching status and type of hospital) were differentially associated with technology use. There is greater use of techniques than pharmaceuticals in US hospitals to reduce the need for allogeneic blood in the peri-operative setting. Providing open-heart surgery is strongly associated with the utilization of these technologies.
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Affiliation(s)
- A B Hutchinson
- Joint PhD Program in Public Policy, Georgia Institute of Technology and Georgia State University, Atlanta GA, USA.
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22
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Chung KC, Kowalski CP, Walters MR. Finger replantation in the United States: rates and resource use from the 1996 Healthcare Cost and Utilization Project. J Hand Surg Am 2000; 25:1038-42. [PMID: 11119660 DOI: 10.1053/jhsu.2000.16356] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Although finger replantation has been performed by hand surgeons in the United States for over 30 years the epidemiology of this procedure has not been studied. We used a national sampling database from the Agency for Health Care Policy and Research to summarize descriptive statistics surrounding finger replantation in the United States. This sample contained 304 cases of finger replantation performed in 1996. Mean hospital length of stay was 5.5 days and mean total charges were $20,330. Of the 906 hospitals included in this database, only 136 performed finger replantation during 1996. Of those, 60% performed only one case and 2% performed 10 or more cases. This descriptive analysis provides an examination of the largest sample size to date of finger replantation in the United States. Epidemiologic studies using national databases can provide researchers and policy makers with the analyses needed to examine treatment options and appropriately allocate future health care resources.
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Affiliation(s)
- K C Chung
- Section of Plastic and Reconstructive Surgery, Department of Surgery, The University of Michigan Medical Center, Ann Arbor 248109-0340, USA
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23
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Abstract
BACKGROUND Older persons who have initial cardiac pacemakers implanted during their final year of life have not been characterized as a group, which makes it difficult to evaluate the suitability of some of their health services utilizations. OBJECTIVE To help determine how prudently pacemakers are used in this group, we assessed its pacemaker candidates from the perspective of health and ability to perform physical activities of daily living. DESIGN A retrospective, population-based, cross-sectional study. SETTING The 1993 National Mortality Followback Survey. PARTICIPANTS An estimated 1,647,955 persons aged 65 years or older who died in the US in 1993. MEASUREMENTS Demographic and cause-of-death frequencies obtained by analyzing age, sex, race, and underlying cause-of-death variables in the survey. For persons who had initial pacemakers implanted during their last year of life, we determined the percent of persons, within 10-year age groups, who had no difficulty at any time during their final year of life performing 11 specific physical activities of daily living (e.g., climbing stairs, preparing meals, bathing). These data were obtained from negative responses to questions that asked if the decedents, at any time during their last year of life, had difficulty performing the specific activities. RESULTS Of the estimated 78,941 persons aged 65 years or older with a pacemaker who died in the US in 1993, 14,158 (18%) had their first pacemaker implanted during their last year of life. Estimated median survival of the final-year-of-life recipients of pacemakers after pacemaker implantation was 5 months. Compared with the general older population that died in 1993, the final-year-of-life recipients of pacemakers group had higher percentages of persons who died of acute disorders (49% vs 19%) and who lived alone in a private home (47% vs 20%), and a lower percentage of persons with Alzheimer's disease (1% vs 7%). The age-stratified means of the percentages of final-year-of-life recipients of pacemakers who had no difficulty performing each physical activity of daily living were all greater than 50. CONCLUSION Our results suggest that older persons who had initial pacemakers implanted during their final year of life and who died in 1993 were not terminally ill, inactive pacemaker candidates, in general, but relatively independent, physically functional candidates who frequently died abruptly. The physical, mental, and life expectancy factors recommended for consideration by expert guidelines for the implantation of cardiac pacemakers were generally applied to persons in this subgroup.
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Affiliation(s)
- B J Hefflin
- Food and Drug Administration, Center for Devices and Radiological Health, Office of Surveillance and Biometrics, Rockville, Maryland 20850, USA
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