title: Implant rates of cardiac implantable electrical devices in Europe: A systematic literature review.
abstract: BACKGROUND
  In 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.
  
  
  OBJECTIVE
  To 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.
  
  
  METHODS
  Four electronic databases were searched to find studies describing CIED implant rates in Europe. Fifty-eight studies were included.
  
  
  RESULTS
  An 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.
  
  
  CONCLUSIONS
  Publications 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.
authors.affiliation: Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy. Electronic address: cinzia.valzania@gmail.com.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Valzania
authors.affiliation: CERGAS, Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Torbica
authors.affiliation: CERGAS, Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy.
authors.forename: Rosanna
authors.initials: R
authors.lastname: Tarricone
authors.affiliation: Aston Medical Research Institute, Aston University Medical School, Birmingham, United Kingdom.
authors.forename: Francisco
authors.initials: F
authors.lastname: Leyva
authors.affiliation: Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy; Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena , Modena, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
mesh_terms: D058409:Cardiac Resynchronization Therapy Devices / Q000706:statistics & numerical data*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005060:Europe; D006801:Humans; D012042:Registries
keywords: Cardiac resynchronization therapy; Implant rates; Implantable defibrillator; Pacemaker; Registries