Access to and clinical use of cardiac implantable electronic devices and interventional electrophysiological procedures in the European Society of Cardiology Countries: 2016 Report from the European Heart Rhythm Association

TLDR

The European Heart Rhythm Association has been collecting descriptive and quantitative data on invasive arrhythmia therapies since 2008. This analysis aims to provide comprehensive information on access to and use of cardiac implantable electronic devices and catheter ablation therapy in the ESC area to help stakeholders understand trends, disparities, and gaps and promote harmonization. Data were compiled from 50 of 56 ESC member countries, presenting up‑to‑date procedure rates over the past five years along with demographics, economic indicators, vital statistics, local healthcare systems, and training activities for each country and the five ESC regions. The analysis revealed substantial heterogeneity in access to arrhythmia therapies across the ESC area, with CIED implantation and catheter ablation rates highest in Western Europe, overall procedure rates 3–10 times higher in European than non‑European ESC countries, and evidence that economic resources alone do not explain utilization patterns, as some low‑GDP Eastern European countries exceeded average rates.

Abstract

The aim of this analysis was to provide comprehensive information on the access to and use of cardiac implantable electronic device (CIED) and catheter ablation therapy in the European Society of Cardiology (ESC) area. The European Heart Rhythm Association (EHRA) has been collecting descriptive and quantitative data on invasive arrhythmia therapies since 2008. This year 50 of the 56 ESC member countries provided data for the EHRA White Book. Up-to-date information on procedure rates for the last 5 years together with information on demographics, economy, vital statistics, local healthcare systems, and training activities is presented for each country and the 5 geographical ESC regions. Our analysis indicated that considerable heterogeneity in the access to arrhythmia therapies still exists across the ESC area. In 2015, the CIED implantation rates per million population were highest in the Western followed by the Southern and Northern European countries. The catheter ablation activity was largest in the Western followed by the Northern and Southern areas. Overall, the procedure rates were 3–10 times higher in the European than in the non-European ESC countries. Economic resources were not the only driver for utilization of arrhythmia therapies as in some Eastern European countries with relative low gross domestic product the procedure rates exceeded the average values. These data will help the healthcare professionals and stakeholders to identify and to understand in more depth the trends, disparities, and gaps in cardiac arrhythmia care and thereby promote harmonization of cardiac arrhythmias therapies in the ESC area.