title: The patient journey from symptom onset to pacemaker implantation.
abstract: BACKGROUND
  Regional variation in permanent pacemaker (PPM) implantation rates is well described, the reasons for which are unclear. Significant delays to PPM implantation in UK practice were described 20 years ago, but contemporary data are lacking.
  
  
  OBJECTIVE
  To investigate delays to PPM implantation and their causes.
  
  
  METHODS
  Prospective observational study in a UK regional pacing centre and its referring district hospitals.
  
  
  METHODS
  A total of 95 consecutive patients receiving first PPM implant for bradycardia indications from 1 June 2006 to 31 August 2006 were included. Hospital records from the referring and implanting centres were reviewed to determine the timings of: symptom onset; first hospital contact; documented pacing indication (defined by 2002 ACC/AHA/NASPE guidelines); referral to implanter; and PPM implantation.
  
  
  RESULTS
  Forty-eight patients (51%) were referred for pacing urgently; median delay from symptoms to PPM 15 days (range 0-7332 days). Forty-seven patients (49%) were referred electively; median delay from symptoms to PPM 380 days (range 33-7505 days), P < 0.0001. Twenty-three of the 47 elective patients (49%) had previous hospitalization with symptoms suggestive of bradycardia. Thirty-three of the 95 patients (35%) had a Class I or IIa pacing indication which did not trigger a pacing referral.
  
  
  CONCLUSIONS
  There are significant delays to PPM implantation in the United Kingdom, longer in those treated electively than those managed as emergencies. Some delays are due to 'process' problems including waiting lists, but a substantial proportion of patients had delays due to failure to refer for pacing once a pacing indication was documented.
authors.affiliation: Department of Cardiology, Freeman Hospital, Freeman Road, Newcastle upon Tyne NE7 7DN, UK. mike.cunnington@ncl.ac.uk
authors.forename: M S
authors.initials: MS
authors.lastname: Cunnington
authors.forename: C J
authors.initials: CJ
authors.lastname: Plummer
authors.forename: A K
authors.initials: AK
authors.lastname: McDiarmid
authors.forename: J M
authors.initials: JM
authors.lastname: McComb
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods; D012017:Referral and Consultation; D013997:Time Factors; D006113:United Kingdom; D014850:Waiting Lists