title: Implantation and patient profiles for pacemakers and cardioverter-defibrillators in France (2008-2009).
abstract: BACKGROUND
  An ageing population and the extension of indications will in all probability result in an increasing number of cardiac device implantations.
  
  
  METHODS
  Patients implanted in 2008 and 2009 were identified by means of the French National Hospital Discharge database to establish the implantation rate and the National Health Insurance (NHI) Information System database for patient profiles (76% of the population).
  
  
  RESULTS
  Of the 64,306 pacemaker implantations (1003.7 per million inhabitants [pmi]) in 2009, 21.4% were single chamber, 75.4% double chamber and 3.2% triple chamber (CRT-P). Of the 9028 cardioverter-defibrillator implantations (140.8 pmi) in 2009, 30.1% were single chamber, 27.5% double chamber and 42.5% triple chamber (CRT-D), accounting for 65% of cardiac resynchronization therapy (CRT) implants. Among NHI beneficiaries, 58.6% of cardioverter-defibrillators were implanted for primary prevention. Between 2008 and 2009, CRT-P implantations increased by 8.8% and CRT-D implantations by 29.3%. Regional variations in implantation rates were observed regarding single-chamber pacemakers (15-33%) and CRT-D among CRT (46.2-73.8%). Pacemaker implantations cost €158.4 million overall, 4.5% of which was for CRT-P; cardioverter-defibrillator implantations cost €96 million, 49% of which was for CRT-D. For NHI beneficiaries, 11.9% of CRT-P patients and 6.5% of CRT-D patients already had a device of the same type implanted in the 3 preceding years.
  
  
  CONCLUSIONS
  The results confirm the increase in cardioverter-defibrillator implantations in France. The implantation rate remains lower than that in the USA but falls within the European average. Reasons behind significant regional variations in implantation rates need further study.
authors.affiliation: Caisse nationale d'assurance maladie des travailleurs salariés, Paris, France. philippe.tuppin@cnamts.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Tuppin
authors.forename: Anke
authors.initials: A
authors.lastname: Neumann
authors.forename: Eloi
authors.initials: E
authors.lastname: Marijon
authors.forename: Christine
authors.initials: C
authors.lastname: de Peretti
authors.forename: Alain
authors.initials: A
authors.lastname: Weill
authors.forename: Philippe
authors.initials: P
authors.lastname: Ricordeau
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
authors.forename: Hubert
authors.initials: H
authors.lastname: Allemand
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial / Q000191:economics / Q000706:statistics & numerical data*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D019992:Databases as Topic; D017147:Defibrillators, Implantable / Q000191:economics / Q000706:statistics & numerical data*; D004554:Electric Countershock / Q000191:economics / Q000295:instrumentation / Q000706:statistics & numerical data*; D004867:Equipment Design; D005260:Female; D005602:France / Q000453:epidemiology; D017048:Health Care Costs; D054625:Healthcare Disparities; D006331:Heart Diseases / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data; D010138:Pacemaker, Artificial / Q000191:economics / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data*; D011314:Preventive Health Services / Q000191:economics / Q000706:statistics & numerical data*; D011474:Prosthesis Design; D012111:Residence Characteristics; D013997:Time Factors
chemical_list: D002317:Cardiovascular Agents