Implant rates of cardiac implantable electrical devices in Europe: A systematic literature review

- Cardiac implantable device implant rates have increased in Europe over time.
- There are geographic differences in implant rates within and across European countries.
- Health care, economic, demographic, and cultural factors may affect implant rate variability.
- Equity of access to implantable devices is a relevant health policy issue.

BackgroundIn recent years, indications for cardiac implantable electrical devices (CIEDs) have broadened; however, budget constraints can significantly impact patient access to these life-saving health technologies.ObjectiveTo perform a systematic literature review on the implant rates of pacemakers, cardioverter-defibrillators, and cardiac resynchronization therapy devices in Europe over the last decade to provide insight into the possible reasons for differences across regions or countries.MethodsFour electronic databases were searched to find studies describing CIED implant rates in Europe. Fifty-eight studies were included.ResultsAn overview showed a recent rise in CIED implants, with large geographic differences. The ratio between the regions with the highest and lowest implant rates within the same country ranged between 1.3 and 3.4 for pacemakers and between 1.7 and 44.0 for defibrillators. The ratio between the countries with the highest and lowest implant rates ranged between 2.3 and 87.5 for pacemakers, between 3.1 and 1548.0 for defibrillators, and between 4.1 and 221.0 for resynchronization therapy devices. Implant rate variability appears to be influenced by health care, economic, demographic, and cultural factors.ConclusionPublications on CIED implant rates in Europe show a wide variability within and across countries, the determinants of which are only partially investigated. Policy making should improve regarding equity of access to better care.