五个欧洲国家 2008-2012 年心脏植入式电子设备使用的五年趋势：利用行政数据库进行跨国比较的案例研究。

Five year trends (2008-2012) in cardiac implantable electrical device utilization in five European nations: a case study in cross-country comparisons using administrative databases.

机构信息

Centre for Research on Health and Social Care Management, Bocconi University, Via Roentgen, 1, 20136 Milan, Italy.

Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Via Albertoni, 15, 40138 Bologna, Italy.

出版信息

Europace. 2018 Apr 1;20(4):643-653. doi: 10.1093/europace/eux123.

DOI:10.1093/europace/eux123

PMID:29016747

Abstract

AIMS

Common methodologies for analysis of analogous data sets are needed for international comparisons of treatment and outcomes. This study tests using administrative hospital discharge (HD) databases in five European countries to investigate variation/trends in pacemaker (PM) and implantable cardioverter defibrillator (ICD) implant rates in terms of patient characteristics/management, device subtype, and initial implantation vs. replacement, and compares findings with existing literature and European Heart Rhythm Association (EHRA) reports.

METHODS AND RESULTS

HD databases from 2008 to 2012 in Austria, England, Germany, Italy and Slovenia were interrogated to extract admissions (without patient identification) associated with PM and ICD implants and replacements, using direct cross-referencing of procedure codes and common methodology to compare aggregate data. 1 338 199 records revealed 212 952 PM and 62 567 ICD procedures/year on average for a 204.4 million combined population, a crude implant rate of about 104/100 000 inhabitants for PMs and 30.6 for ICDs. The first implant/replacement rate ratios were 81/24 (PMs) and 25/7 (ICDs). Rates have increased, with cardiac resynchronization therapy (CRT) subtypes for both devices rising dramatically. Significant between- and within-country variation persists in lengths of stay and rates (Germany highest, Slovenia lowest). Adjusting for age lessened differences for PM rates, scarcely affected ICDs. Male/female ratios remained stable at 56/44% (PMs) and 79/21% (ICDs). About 90% of patients were discharged to home; 85-100% were inpatient admissions.

CONCLUSION

To aid in policymaking and track outcomes, HD administrative data provides a reliable, relatively cheap, methodology for tracking implant rates for PMs and ICDs across countries, as comparisons to EHRA data and the literature indicated.

摘要

目的

需要采用通用的分析方法来分析类似的数据集，以便在国际范围内比较治疗和预后结果。本研究使用来自五个欧洲国家的医院出院（HD）行政数据库来研究起搏器（PM）和植入式心脏复律除颤器（ICD）植入率的变化/趋势，具体涉及患者特征/管理、器械类型、初始植入与更换，同时将研究结果与现有文献和欧洲心律协会（EHRA）的报告进行比较。

方法和结果

对 2008 年至 2012 年奥地利、英国、德国、意大利和斯洛文尼亚的 HD 数据库进行查询，提取与 PM 和 ICD 植入和更换相关的入院记录（不包含患者身份信息），使用程序代码的直接交叉引用和通用方法来比较汇总数据。共获得 212952 例 PM 和 62567 例 ICD 手术/年，20440 万合并人口的平均粗植入率分别约为 104/10 万居民用于 PMs 和 30.6 用于 ICDs。首次植入/更换的比率分别为 81/24（PMs）和 25/7（ICDs）。随着两种设备的心脏再同步治疗（CRT）亚类的显著增加，植入率呈上升趋势。住院时间和比率在国家之间和国家内部仍存在显著差异（德国最高，斯洛文尼亚最低）。调整年龄后，PM 比率的差异减小，对 ICD 几乎没有影响。男女比例保持稳定，分别为 56/44%（PMs）和 79/21%（ICDs）。约 90%的患者出院回家；85-100%为住院患者。