title: Survey of cardiac rhythm management and device implant patterns in Puerto Rico: analysis of 13,854 cardiac implants.
abstract: BACKGROUND
  Surveys of cardiac pacing and implantable cardiovertor defibrillators (ICD) have been reported since 1969 and 1993 respectively. Increasing costs of medical technology, budget constraints and emergent new clinical indications prompted our committee to conduct the first survey of cardiac rhythm management and device implant patterns in Puerto Rico.
  
  
  METHODS
  Clinical and demographic data were obtained for all cardiac devices sold and implanted from 2000 to 2006, through a joint agreement with official representatives of the 2 largest manufacturers and distributors of cardiac pacemakers and ICD in Puerto Rico.
  
  
  RESULTS
  13,854 cardiac devices were implanted from 2000 to 2006. The number of permanent pacemakers (PP) implanted per million population has varied from 430 in the year 2000 to 482 in the year 2006. A significant greater number of males received PP than females (P < .05). Yearly increases in implant rates for cardiac resynchronization therapy (CRT) and ICD were observed, mainly due to new emergent clinical indications, appropriate insurance coverage and availability of implanting electrophysiologists.
  
  
  CONCLUSIONS
  Sales figures from PP and ICD manufacturers are a reliable system to calculate and analyze changes in cardiac device implant patterns. The rate of 482 PP per million population positions Puerto Rico as the third largest implant market in North and South America. This finding should be useful to insurance health providers since 76% of the implants are performed in patients over 65 years old. In the year 2006, Puerto Rico was the 10th largest implant market in the world with 67 CRT implanted per million population. A significant greater number of CRT and ICD were implanted in males than females. This gender difference has increased in spite of strict requirements to include more females in clinical trials and intensive, educational and awareness efforts conducted among physicians and patients. A summary of the current guidelines and clinical indications is provided to assist the physician in the selection of patients referred for cardiac rhythm management and implant procedures.
authors.affiliation: Cardiovascular Center of Puerto Rico.
authors.forename: Juan M
authors.initials: JM
authors.lastname: Aranda
authors.forename: Miguel
authors.initials: M
authors.lastname: Girod
authors.forename: Fernando
authors.initials: F
authors.lastname: Ochoa
authors.forename: Miguel
authors.initials: M
authors.lastname: Abreu
authors.forename: José J
authors.initials: JJ
authors.lastname: Rivera
authors.forename: Juan C
authors.initials: JC
authors.lastname: Sotomonte
authors.forename: Angel
authors.initials: A
authors.lastname: Rodríguez
authors.forename: Daniel
authors.initials: D
authors.lastname: Arzola
authors.forename: Raúl
authors.initials: R
authors.lastname: Fiménez
authors.forename: Juan M
authors.initials: JM
authors.lastname: Aranda