Pacemaker and Implantable Defibrillator Complication Rates Appear Hospital-Specific, Study Finds

Complication rates with pacemakers and implantable defibrillators often vary widely based on the hospital where the procedure occurred, according to the findings of a new study.

In a report published last week in the Annals of Internal Medicine, Australian researchers indicate that one of the biggest factors impacting the implantable defibrillator complication rates may be the hospital where they were implanted.

Cardiac implantable electronic devices (CIEDs) include permanent pacemakers, implantable cardioverter defibrillators, and cardiac resynchronization therapy devices. They are used to keep a patient’s heart continuously beating after suffering a serious cardiac event, such as heart attack or other problem that required continued electrical stimulation.

Researchers from the University of Adelaide in Australia looked at data from 174 hospitals in Australia and New Zealand. Of those, 98 hospitals implanted at least 25 or more CIEDs during the study period from 2010 to 2015.

The data involved 81,300 patients ages 18 or older; 40% of whom received a new CIED. More than 65,000 received permanent pacemakers and nearly 16,000 received implantable cardioverter defibrillators (ICDs).

Overall, 8% of patients who received a CIED of any kind suffered a major complication or side effect within 90 days of the operation. Roughly 60% occurred after the patient left the hospital.

Complication rates differed between 2- and 3-fold among different hospitals. Complication rates for implantable cardioverter defibrillators were 10%, compared to permanent pacemakers at 7%. However, 76% of complications were attributed to permanent pacemakers, since they are implanted in much larger numbers.

The study indicates complication rates just for permanent pacemakers varied from 5% to 13% and complication rates for implantable cardioverter defibrillators ranged from 6% to 17%.

Researchers determined the widely differing complication rates suggest hospital care also varies widely. The average complication rate was 8%, but the complication rates varied from 5%to 14%. According to the data, 22 hospitals were identified as having complication rates that were significantly different from the national average.

Prior studies have shown CIEDs are beneficial to patients and carry small complication risks ranging from 3 to 6%. However, researchers warn the findings of those studies don’t account for the change in quality of care from one hospital to another, since they are from large clinical trials. Instead, they claim the new research reveals more accurate complication rates.