Author + information
- Received March 13, 2012
- Revision received June 26, 2012
- Accepted July 2, 2012
- Published online October 16, 2012.
- Arnold J. Greenspon, MD⁎,⁎ (, )
- Jasmine D. Patel, PhD†,‡,
- Edmund Lau, MS†,‡,
- Jorge A. Ochoa, PhD‡,
- Daniel R. Frisch, MD⁎,
- Reginald T. Ho, MD⁎,
- Behzad B. Pavri, MD⁎ and
- Steven M. Kurtz, PhD†,‡
- ↵⁎Reprint requests and correspondence:
Dr. Arnold J. Greenspon, Jefferson Heart Institute, 925 Chestnut Street, Mezzanine, Philadelphia, Pennsylvania 19107
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.
Dr. Greenspon reports that he receives honoraria for speakers' fees from Medtronic, Boston Scientific, and St. Jude Medical. Dr. Lau is an employee of Exponent Inc.; and has received research grants from Medtronic, Stryker, BIOMET, and Exponent, Inc. Dr. Ochoa is an employee of Exponent, Inc. Dr. Ho has received honoraria from Medtronic, St. Jude Medical, and Boston Scientific. Dr. Pavri has received speakers' fees from Medtronic, St. Jude Medical, Boston Scientific, and Biotronik. Dr. Kurtz has received institutional support from Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 13, 2012.
- Revision received June 26, 2012.
- Accepted July 2, 2012.
- American College of Cardiology Foundation