Cardiac Device Implantation in the United States from 1997 through 2004: A Population-based Analysis

Center for Outcomes and Evidence, Agency for Healthcare Research and Quality, Rockville, MD, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 02/2008; 23 Suppl 1(Suppl 1):13-9. DOI: 10.1007/s11606-007-0392-0
Source: PubMed


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.

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    • "especially as a result of an increase in general life expectancy in the elderly population (Uslan et al. 2008, Zhan et al. 2008). Electromagnetic interference (EMI) in implanted cardiac devices occurs when an external signal interferes with PMs and ICDs by temporary inhibition of pacing, temporary change in the modality of stimulation or inappropriate functioning of the cardiac device (Sager 1987, Niehaus & Tebbenjohanns 2001). "
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    ABSTRACT: To evaluate the potential for electromagnetic interference (EMI) of electronic apex locators (EALs) and a gutta-percha heating device (HD) in patients with implantable cardiac pacemakers (ICPs) or cardioverter defibrilators (ICDs). Two types of EALs (Romiapex A-15 and Novapex) and a HD (Touch 'n heat) were tested in patients followed in an outpatient clinic for cardiac arrhythmias. The heart rhythm was monitored on a computer screen during all experimental phases. After baseline data collection, the patient held each appliance (turned on) for 30 seconds, simulating their clinical use. If background noise was detected on the cardiac monitor, the sensitivity of the ICP/ICD was lowered by the cardiologist in order to evaluate the intensity of the detected EMI. Twelve patients were evaluated (5 female and 7 male) and in nine instances, background noise in their cardiac devices related to the use of the endodontic devices was detected (6 patients). After lowering the sensitivity of the cardiac implants, three patients had more severe EMI in six instances, including pauses in ICP function. The presence of a symptomatic or asymptomatic pause was related to the patient's underlying heart rhythm. The HD device produced background noise more often compared to EALs. These were associated with more severe types of EMI. The tested EALs and gutta-percha HD are capable of causing background noise detection or pauses in cardiac implants in vivo. The use of electronic dental devices nearby patients with cardiac implants should be carefully considered in clinical practice. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    International Endodontic Journal 06/2015; DOI:10.1111/iej.12487 · 2.97 Impact Factor
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    • "In other systems, designers use cryptographic methods to provide confidentiality and prevent unauthorized access . However, adding cryptography directly to IMDs themselves is difficult for the following reasons: • Inalterability: In the U.S. alone, there are millions of people who already have wireless IMDs, and about 300,000 such IMDs are implanted every year [56]. Once implanted, an IMD can last up to 10 years [12], and replacing it requires surgery that carries risks of major complications. "
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    ABSTRACT: Wireless communication has become an intrinsic part of modern implantable medical devices (IMDs). Recent work, however, has demonstrated that wireless connectivity can be exploited to compromise the confidentiality of IMDs' transmitted data or to send unauthorized commands to IMDs---even commands that cause the device to deliver an electric shock to the patient. The key challenge in addressing these attacks stems from the difficulty of modifying or replacing already-implanted IMDs. Thus, in this paper, we explore the feasibility of protecting an implantable device from such attacks without modifying the device itself. We present a physical-layer solution that delegates the security of an IMD to a personal base station called the shield. The shield uses a novel radio design that can act as a jammer-cum-receiver. This design allows it to jam the IMD's messages, preventing others from decoding them while being able to decode them itself. It also allows the shield to jam unauthorized commands---even those that try to alter the shield's own transmissions. We implement our design in a software radio and evaluate it with commercial IMDs. We find that it effectively provides confidentiality for private data and protects the IMD from unauthorized commands.
    Proceedings of the ACM SIGCOMM 2011 Conference on Applications, Technologies, Architectures, and Protocols for Computer Communications, Toronto, ON, Canada, August 15-19, 2011; 01/2011
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    • "Increasing burden of cardiovascular disease and broadening indications have led to a significant increase in the implantation of cardiac rhythm management devices (CRMDs) [1] [2] [3]. Approximately 70% of CRMD recipients are ≥65 years of age and 20%–35% are older than 80 years [1– 4]. "
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    ABSTRACT: Lead perforation is a major complication of cardiac rhythm management devices (CRMD), occurring in about 1%. While most lead perforations occur early, numerous instances of delayed lead perforation (occurring >30 days after implantation) have been reported in the last few years. Only about 40 such cases have been published, with the majority occurring <1 year after implantation. Herein, we describe the case of an 84-year-old female who presented with recurrent syncope and was diagnosed to have delayed pacemaker lead perforation 4.8 years after implantation. Through this report, we intend to highlight the increasing use of CRMD in elderly patients, and the lifelong risk of complications with these devices. Presentation can be atypical and a high index of suspicion is necessary for diagnosis.
    Cardiology Research and Practice 07/2010; 2010(8). DOI:10.4061/2010/741751
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