Variation in regional implantation patterns of cardiac implantable electronic device in Switzerland.

Bolt, Lucy; Wertli, Maria M.; Haynes, Alan G.; Rodondi, Nicolas; Chiolero, Arnaud; Panczak, Radoslaw; Aujesky, Drahomir (2022). Variation in regional implantation patterns of cardiac implantable electronic device in Switzerland. PLoS ONE, 17(2), e0262959. Public Library of Science 10.1371/journal.pone.0262959

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR)
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine

UniBE Contributor:

Bolt, Lucy Lynne, Wertli, Maria Monika, Haynes, Alan, Rodondi, Nicolas, Chiolero, Arnaud, Panczak, Radoslaw, Aujesky, Drahomir

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1932-6203

Publisher:

Public Library of Science

Funders:

[4] Swiss National Science Foundation ; [24] Gottfried und Julia Bangerter- Rhyner Stiftung ; [214] SGAIM Foundation (Swiss Society of General Internal Medicine Foundation) = Stiftung der Schweizerischen Gesellschaft für Allgemeine Innere Medizin

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

17 Feb 2022 18:10

Last Modified:

20 Feb 2024 14:16

Publisher DOI:

10.1371/journal.pone.0262959

Related URLs:

PubMed ID:

35171922

BORIS DOI:

10.48350/165705

URI:

https://boris.unibe.ch/id/eprint/165705

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