TY - JOUR
T1 - Trends in cardiac implantable electronic device utilization in adults with congenital heart disease
T2 - a US nationwide analysis
AU - Bhalla, Jaideep Singh
AU - Majmundar, Monil
AU - Patel, Kunal N.
AU - Deshmukh, Abhishek J.
AU - Connolly, Heidi M.
AU - Chirac, Anca
AU - Egbe, Alexander C.
AU - Miranda, William R.
AU - Madhavan, Malini
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023.
PY - 2024/3
Y1 - 2024/3
N2 - Background: Adults with congenital heart disease (ACHD) have increased risk of arrhythmias warranting implantation of cardiac implantable electronic devices (CIEDs), which may parallel the observed increase in survival of ACHD patients over the past few decades. We sought to characterize the trends and outcomes of CIED implantation in the inpatient ACHD population across US from 2005 to 2019. Methods: A retrospective analysis of the Nationwide Inpatient Sample (NIS) identified 1,599,519 unique inpatient ACHD admissions (stratified as simple (85.1%), moderate (11.5%), and complex (3.4%)) using the International Classification of Diseases 9/10-CM codes. Hospitalizations for CIED implantation (pacemaker, ICD, CRT-p/CRT-d) were identified and the trends analyzed using regression analysis (2-tailed p < 0.05 was considered significant). Results: A significant decrease in the hospitalizations for CIED implantation across the study period [3.3 (2.9–3.8)% in 2005 vs 2.4 (2.1–2.6)% in 2019, p < 0.001] was observed across all types of devices and CHD severities. Pacemaker implantation increased with each age decade, whereas ICD implantation rates decreased over 70 years of age. Complex ACHD patients receiving CIED were younger with a lower prevalence of age-related comorbidities, however, had a greater prevalence of atrial/ventricular tachyarrhythmias and complete heart block. The observed inpatient mortality rate was 1.2%. Conclusions: In a nationwide analysis, we report a significant decline in CIED implantation between 2005 and 2019 in ACHD patients. This may either be due to a greater proportion of hospitalizations resulting from other complications of ACHD or reflect a declining need for CIED due to advances in medical/surgical therapies. Future prospective studies are needed to elucidate this trend further.
AB - Background: Adults with congenital heart disease (ACHD) have increased risk of arrhythmias warranting implantation of cardiac implantable electronic devices (CIEDs), which may parallel the observed increase in survival of ACHD patients over the past few decades. We sought to characterize the trends and outcomes of CIED implantation in the inpatient ACHD population across US from 2005 to 2019. Methods: A retrospective analysis of the Nationwide Inpatient Sample (NIS) identified 1,599,519 unique inpatient ACHD admissions (stratified as simple (85.1%), moderate (11.5%), and complex (3.4%)) using the International Classification of Diseases 9/10-CM codes. Hospitalizations for CIED implantation (pacemaker, ICD, CRT-p/CRT-d) were identified and the trends analyzed using regression analysis (2-tailed p < 0.05 was considered significant). Results: A significant decrease in the hospitalizations for CIED implantation across the study period [3.3 (2.9–3.8)% in 2005 vs 2.4 (2.1–2.6)% in 2019, p < 0.001] was observed across all types of devices and CHD severities. Pacemaker implantation increased with each age decade, whereas ICD implantation rates decreased over 70 years of age. Complex ACHD patients receiving CIED were younger with a lower prevalence of age-related comorbidities, however, had a greater prevalence of atrial/ventricular tachyarrhythmias and complete heart block. The observed inpatient mortality rate was 1.2%. Conclusions: In a nationwide analysis, we report a significant decline in CIED implantation between 2005 and 2019 in ACHD patients. This may either be due to a greater proportion of hospitalizations resulting from other complications of ACHD or reflect a declining need for CIED due to advances in medical/surgical therapies. Future prospective studies are needed to elucidate this trend further.
KW - CHD
KW - Cardiac implantable electronic device, NIS
KW - Cardiac resynchronization therapy-pacemaker/defibrillator, ICD
KW - Congenital heart disease, CRT-P/D
KW - Electrophysiology, CIED
KW - Implantable cardioverter-defibrillator, EP
KW - Nationwide Inpatient Sample
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UR - http://www.scopus.com/inward/citedby.url?scp=85163750193&partnerID=8YFLogxK
U2 - 10.1007/s10840-023-01601-0
DO - 10.1007/s10840-023-01601-0
M3 - Article
C2 - 37392273
AN - SCOPUS:85163750193
SN - 1383-875X
VL - 67
SP - 319
EP - 328
JO - Journal of Interventional Cardiac Electrophysiology
JF - Journal of Interventional Cardiac Electrophysiology
IS - 2
ER -