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In 2008, The American College of Cardiology/American Heart Association/Heart Rhythm Society issued revised guidelines for automatic implantable cardioverter-defibrillators (AICD). We hypothesized that these guidelines have influenced AICD implantation rates.
We queried the NIS database to identify AICD implantations between 2004 and 2011 using the International Classification of Diseases-Ninth Revision-Clinical Modification procedure codes for AICD. Annual permanent pacemaker implantation rates were analyzed. All trend analyses were conducted using SAS 9.4. Yearly weighted frequencies for each procedure were generated using the ‘trendwt’ variable. The effect of 2008 HRS guidelines was assessed by grouping years 2004-2009 and 2010-2011, and then testing for mean difference.
Over 680,000 AICD devices were placed in the United States in 2004. This rate showed a steady decline with only around 460,000 device implantations in 2011. Between 2004 and 2009, the mean number of AICD placements was 1932 (95% CI 1674, 2191). After publication of revised guidelines in 2008, the mean placement volume per state dropped to 1176 (95% CI 903, 1450). Assuming unequal variance between the two groups (Folded F p value < 0.0001) this decline was statistically significant at alpha=0.05 (p value < 0.0001).
This study using the national inpatient sample database to evaluate pacemaker placement trends suggests a gradual decrease in AICD device implantation over the past decade. It reaffirms our hypothesis that the 2008 HRS guidelines significantly influenced the rate of PPM implantation in the United States. These trends have important health care policy implications.