title: Trends in permanent pacemaker implantation in the United States from 1993 to 2009: increasing complexity of patients and procedures.
abstract: OBJECTIVE
  This study sought to define contemporary trends in permanent pacemaker use by analyzing a large national database.
  
  
  BACKGROUND
  The Medicare National Coverage Determination for permanent pacemaker, which emphasized single-chamber pacing, has not changed significantly since 1985. We sought to define contemporary trends in permanent pacemaker use by analyzing a large national database.
  
  
  METHODS
  We queried the Nationwide Inpatient Sample to identify permanent pacemaker implants between 1993 and 2009 using the International Classification of Diseases-Ninth Revision-Clinical Modification procedure codes for dual-chamber (DDD), single-ventricular (VVI), single-atrial (AAI), or biventricular (BiV) devices. Annual permanent pacemaker implantation rates and patient demographics were analyzed.
  
  
  RESULTS
  Between 1993 and 2009, 2.9 million patients received permanent pacemakers in the United States. Overall use increased by 55.6%. By 2009, DDD use increased from 62% to 82% (p < 0.001), whereas single-chamber ventricular pacemaker use fell from 36% to 14% (p = 0.01). Use of DDD devices was higher in urban, nonteaching hospitals (79%) compared with urban teaching hospitals (76%) and rural hospitals (72%). Patients with private insurance (83%) more commonly received DDD devices than Medicaid (79%) or Medicare (75%) recipients (p < 0.001). Patient age and Charlson comorbidity index increased over time. Hospital charges ($2011) increased 45.3%, driven by the increased cost of DDD devices.
  
  
  CONCLUSIONS
  There is a steady growth in the use of permanent pacemakers in the United States. Although DDD device use is increasing, whereas single-chamber ventricular pacemaker use is decreasing. Patients are becoming older and have more medical comorbidities. These trends have important health care policy implications.
authors.affiliation: Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. arnold.greenspon@jefferson.edu
authors.forename: Arnold J
authors.initials: AJ
authors.lastname: Greenspon
authors.forename: Jasmine D
authors.initials: JD
authors.lastname: Patel
authors.forename: Edmund
authors.initials: E
authors.lastname: Lau
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Ochoa
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Frisch
authors.forename: Reginald T
authors.initials: RT
authors.lastname: Ho
authors.forename: Behzad B
authors.initials: BB
authors.lastname: Pavri
authors.forename: Steven M
authors.initials: SM
authors.lastname: Kurtz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008297:Male; D010138:Pacemaker, Artificial / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D019919:Prosthesis Implantation / Q000639:trends; D012804:Sick Sinus Syndrome / Q000628:therapy; D012848:Sinoatrial Block / Q000628:therapy; D014481:United States / Q000453:epidemiology