Zhan Chunliu, Baine William B, Sedrakyan Artyom, Steiner Claudia
Center for Outcomes and Evidence, Agency for Healthcare Research and Quality, Rockville, MD, USA.
J Gen Intern Med. 2008 Jan;23 Suppl 1(Suppl 1):13-9. doi: 10.1007/s11606-007-0392-0.
Use of cardiac devices has been increasing rapidly along with concerns over their safety and effectiveness. This study used hospital administrative data to assess cardiac device implantations in the United States, selected perioperative outcomes, and associated patient and hospital characteristics.
We screened hospital discharge abstracts from the 1997-2004 Healthcare Cost and Utilization Project Nationwide Inpatient Samples. Patients who underwent implantation of pacemaker (PM), automatic cardioverter/defibrillator (AICD), or cardiac resynchronization therapy pacemaker (CRT-P) or defibrillator (CRT-D) were identified using ICD-9-CM procedure codes. Outcomes ascertainable from these data and associated hospital and patient characteristics were analyzed.
Approximately 67,000 AICDs and 178,000 PMs were implanted in 2004 in the United States, increasing 60% and 19%, respectively, since 1997. After FDA approval in 2001, CRT-D and CRT-P reached 33,000 and 7,000 units per year in the United States in 2004. About 70% of the patients were aged 65 years or older, and more than 75% of the patients had 1 or more comorbid diseases. There were substantial decreases in length of stay, but marked increases in charges, for example, the length of stay of AICD implantations halved (from 9.9 days in 1997 to 5.2 days in 2004), whereas charges nearly doubled (from $66,000 in 1997 to $117,000 in 2004). Rates of in-hospital mortality and complications fluctuated slightly during the period. Overall, adverse outcomes were associated with advanced age, comorbid conditions, and emergency admissions, and there was no consistent volume-outcome relationship across different outcome measures and patient groups.
The numbers of cardiac device implantations in the United States steadily increased from 1997 to 2004, with substantial reductions in length of stay and increases in charges. Rates of in-hospital mortality and complications changed slightly over the years and were associated primarily with patient frailty.
随着对心脏设备安全性和有效性担忧的增加，其使用量一直在迅速上升。本研究利用医院管理数据评估美国心脏设备植入情况、选定的围手术期结局以及相关的患者和医院特征。
我们筛选了1997 - 2004年医疗成本和利用项目全国住院患者样本中的医院出院摘要。使用ICD - 9 - CM程序编码识别接受起搏器（PM）、自动心脏复律除颤器（AICD）或心脏再同步治疗起搏器（CRT - P）或除颤器（CRT - D）植入的患者。分析了可从这些数据中确定的结局以及相关的医院和患者特征。
2004年美国植入了约67,000个AICD和178,000个PM，自1997年以来分别增长了60%和19%。2001年美国食品药品监督管理局（FDA）批准后，2004年CRT - D和CRT - P在美国每年分别达到33,000台和7,000台。约70%的患者年龄在65岁及以上，超过75%的患者患有一种或多种合并症。住院时间大幅缩短，但费用显著增加，例如，AICD植入的住院时间减半（从1997年的9.9天降至2004年的5.2天），而费用几乎翻倍（从1997年的66,000美元增至2004年的117,000美元）。在此期间，住院死亡率和并发症发生率略有波动。总体而言，不良结局与高龄、合并症和急诊入院相关，并且在不同的结局指标和患者群体中没有一致的值 - 结局关系。
1997年至2004年美国心脏设备植入数量稳步增加，住院时间大幅缩短，费用增加。这些年住院死亡率和并发症发生率变化不大，主要与患者身体虚弱有关。
