Temporal Trends in Cardiovascular Implantable Electronic Device Implants
and Upgrades in the US Between 2016-2019: Insights from the National
Inpatient Database
Abstract
Background: Cardiovascular implantable electronic device (CIED)
technology continue to advance and improve overtime to help in the
treatment of various bradyarrhythmia and prevent sudden cardiac death.
Trends and types of various CIED insertion has been changing over the
past two decades. No recent study has captured trends in procedures
related to several categories of implantable devices in United States
(US) subgroups. Objective: We conducted a nationwide
subcategory analysis of trends in device implants from 2016 to 2019
using the US National Inpatient Sample (NIS) database. Methods:
We used data from the NIS between January 2016 to December 2019 on
hospitalized adults ≥18 years old undergoing CIED implants and/or device
upgrades to study CIED device trends each year stratified by baseline
characteristics and comorbid conditions. Linear regression for
continuous outcomes and logistic regression for categorical outcomes
were used to calculate p-value trends for each subcategory.
Results: We found a significant increase in implantation rates
of all CIEDs in the US from 2016 to 2019 (150,370 to 159,300). There was
a significant increase in dual-chamber compared to single-chamber
pacemaker and implanted cardioverter defibrillator devices implanted
noted (p <0.001), and an increase in permanent pacemaker to
cardiac resynchronization therapy pacemaker upgrades from 1,280 to 1,615
(p = 0.002). When stratified by gender, the percentage of all CIEDs were
higher in males than females. No significant change was shown when
stratified by age, race, or comorbidity. Conclusion: The
findings likely mirror the increasing prevalence of conduction
abnormalities in the US and account for the better understanding that
dual pacing better emulates normal cardiac physiology and
atrioventricular synchrony .