Cardiac Rhythm Management Audit shows variation in implantation rates for pacemakers and defibrillators, nationally and in comparison to Europe

Published: 14 Feb 2017

The National Cardiac Rhythm Management (CRM) Audit data suggests that within the UK there continues to be variation in the rates of pacemaker and defibrillator implants in both the UK and Western Europe. This may reflect patients not presenting, limited access to diagnostic tests, lack of referral for treatment, or poor training.

CRM devices are life-saving treatments for heart rhythm disorders including blackouts and sudden cardiac arrest. It is essential that patients get the right diagnosis and the most appropriate treatment, promptly. By monitoring the implantation of these devices, it is possible to identify geographical variation both within the UK and compared to other nations

Read the full report here

The audit commissioned and managed by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patients Outcomes Programme (NCAPOP) covers 1 April 2015 to 31 March 2016. The audit is held by the National Institute for Cardiac Outcomes Research and led clinically by the British Heart Rhythm Society

Audit report key findings:

• Although pacemaker and defibrillator implant rates in the UK are gradually increasing, they remain consistently low in Western Europe

• There is great variation within the UK in the rates of all types of implants

• The UK is one of the top countries in Europe performing cardiac resynchronization therapy – a technique that improves the coordination of the heart in patients with heart failure

• A significant number of UK hospitals continue to perform small numbers of pacemaker and defibrillator implants

For pacemakers, the number of such hospitals has halved in the last year, but for more complex devices, almost 50% of hospitals do not meet recommended minima. Dr Francis Murgatroyd, Chair of the British Heart Rhythm Society Audit Committee and Clinical Lead of the CRM Audit said:

“This report highlights that the UK implants fewer pacemakers and defibrillators that other European countries. While some parts of the country have good services, in others patients are half as likely to receive the correct diagnosis and treatment, and may be treated in a centre with very low levels of experience. We propose that commissioners and hospitals tackle this issue on a planned, network basis, to establish standards and pathways of care, and ensure that patients receive the correct diagnosis and treatment wherever they live in the UK.”

The eleventh devices annual report for the National Cardiac Rhythm Management Audit presents an official record of cardiac device implants and recommendations based on these procedures performed between 1st April 2015 and 31st March 2016. The report includes data from 196 implanting centres in England, Northern Ireland, Scotland and Wales and shows trends in the use of this therapy.

The National Audit of Cardiac Rhythm Management, hosted by the National Institute for Cardiovascular Outcomes Research (NICOR), manages data submitted by hospitals on patients with implanted devices or undergoing ablation for management of cardiac rhythm disorders. It was established as the National Pacemaker Database (NPDB) in the late 1970s by Dr Anthony Rickards. The database now contains close to 1,000,000 records and is the largest in the world.