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Impact of socioeconomic aspects on cardiac implantable electronic device treatment and application of the EHRA guidelines

A European comparison

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Summary

Background

Cardiac implantable electronic devices (CIED) have become an indispensable part in everyday clinical practice in cardiology. The indications for CIED implantation are based on the guidelines of the European Heart Rhythm Association (EHRA). Nevertheless, numbers of CIED implantations in Europe are subject to considerable differences. We hypothesized that reimbursements linked to the respective health systems may influence implantation behavior.

Methods

Based on the EHRA White Book 2017, CIED implantation data as well as socioeconomic key figures were collected, in particular gross domestic product (GDP) and share of gross domestic product spent on healthcare.

Implantation numbers for pacemakers, implantable cardioverter defibrillators and cardiac resynchronization treatment as well as all in total were assessed, compared with the health care expenditures and visualized using heat maps.

Results

Total implantation numbers per 100,000 inhabitants varied from 196.53 (Germany) to 2.81 (Kosovo). Higher implantation numbers correlated moderately with a higher GDP (r = 0.456, p 0.002) and higher health expenditure (r = 0.586, p < 0.001). The annual financial resources per inhabitant were also subject to fluctuations ranging from 9476 $ (Switzerland) to 140 $ (Ukraine); however, there were countries with high financial means, such as Switzerland or Scandinavian countries, which showed significantly lower implantation rates.

Conclusion

There were considerable differences in CIED implantations in Europe. These seem to be explained in part by socioeconomic disparities within Europe. Also, a potential influence by the respective remuneration system is likely.

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Acknowledgements

The data presented in this study was partly used in the preparation of a thesis for the degree program “Health Sciences, Leadership” at Paracelsus Medical Private University Salzburg, Austria, written in German by the corresponding author C. E.

Funding

This research received no specific funding from public, commercial or non-profit institutions.

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Authors and Affiliations

  1. Department of Cardiology, Heart Center Brandenburg, Ladeburger Str. 17, 16321, Bernau, Germany

    Marwin Bannehr, David Reiners, Christian Georgi, Christian Butter & Christoph Edlinger MD

  2. Brandenburg Medical School (MHB) “Theodor Fontane”, Neuruppin, Germany

    Marwin Bannehr, David Reiners, Christian Georgi, Christian Butter & Christoph Edlinger MD

  3. Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria

    Michael Lichtenauer, Kristen Kopp, Peter Jirak & Christoph Edlinger MD

Authors
  1. Marwin Bannehr
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  2. David Reiners
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  6. Christian Georgi
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  7. Christian Butter
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  8. Christoph Edlinger MD
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Contributions

M. B. acquired and interpreted data, performed statistic calculations and contributed in manuscript preparation. D. R. acquired study data, performed statistic calculations and revised the manuscript. M. L., K. K,. C. G., P. J. and C. B. revised the article critically for the content. C. E. planned and coordinated the study, acquired, analyzed and interpreted data, prepared figures, contributed in manuscript preparation and provided final approval of the article. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Christoph Edlinger MD.

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Conflict of interest

M. Bannehr, D. Reiners, M. Lichtenauer, K. Kopp, P. Jirak, C. Georgi, C. Butter, and C. Edlinger declare that they have no competing interests.

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Bannehr, M., Reiners, D., Lichtenauer, M. et al. Impact of socioeconomic aspects on cardiac implantable electronic device treatment and application of the EHRA guidelines. Wien Klin Wochenschr 134, 646–653 (2022). https://doi.org/10.1007/s00508-022-02056-5

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  • DOI: https://doi.org/10.1007/s00508-022-02056-5

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