Causes of differences in the uptake of cardiac implantation electronic devices in Slovenia in comparison to other countries

Figure 1

Comparison of the data on numbers of PMs and ICDs from national hospital discharge database with the data published in the European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC)_

	Slovenia			Austria			All UK England			Germany			Italy
Year	EHRA	Hospitals	Diff	EHRA	Hospitals	Diff	EHRA	Hospitals	Diff	EHRA	Hospitals	Diff	EHRA	Hospitals	Diff
Pacemakers
2008	1100	586	-88%	7570	7690	2%	40570	37734	-8%	98300	89194	-10%	61300	62220	2%
2009	935	652	-43%	7930	7500	-6%	39850	42701	7%	102177	92215	-11%	63000	62215	-1%
2010	1153	602	-92%	7712	7589	-2%	37194	45636	18%	103423	94659	-9%	63400	62202	-2%
2011	1295	604	-114%	7810	7870	1%	38239	50540	24%	106953	96013	-11%	63100	62141	-2%
2012	1333	667	-100%	7870	7950	1%	38770	0		106567	96403	-11%	61300	62098	1%
ICDs
2008	96	103	7%	1100	1104	0%	7403	5086	-46%	21600	20948	-3%	18000	16554	-8%
2009	111	145	23%	1290	1157	-11%	5077	5376	6%	23574	22940	-3%	10500	15100	30%
2010	101	176	43%	1268	1176	-8%	5175	5344	3%	25071	24422	-3%	11100	13933	20%
2011	144	174	17%	1805	1195	-51%	5404	5467	1%	26579	25219	-5%	11970	14106	15%
2012	122	196	38%	1195	1296	8%	5762	0		26536	25956	-2%	12000	13943	14%

Charlson Comorbidity Index – average of weighted CCI scores for each category of device, by country for the year 2011_

		Austria	England	Germany	Italy	Slovenia
	Overall CCI scores
PM implants		0.10	0.90	1.63	0.96	1.07
ICD implants		0.58	1.32	2.50	1.27	1.52
PM implants	Acute myocardial infarction (AMI)	1%	1%	9%	5%	6%
	Congestive Heart Failure	4%	15%	32%	13%	23%
	Diabetes	N/A	17%	20%	11%	22%
ICD implants	AMI	2%	5%	35%	14%	26%
	Congestive Heart Failure	54%	60%	91%	73%	63%
	Diabetes	0%	20%	25%	13%	16%

Main reasons for difference in data in CIEDs uptake in 5 European countries (2008-2012)_

The reason for the difference in the data	A description
The use of Australian coding system valid until 21 December in Slovenia	No codes for PM replacement Some codes were valid only until 31 December 2010 Not specific enough (no codes for single chamber, dual chamber, BV/CRT, CRT_P or CRT_D procedures)
Only a partial link between financing and DRG coding in Slovenia	In Slovenia, coding is considered as an additional administrative burden
No golden rule for the optimal crude utilisation rate	In Slovenia, an absolute indication is needed to receive the implant
Variations in relative indications, financial restrictions and other contextual factors across countries	Differences in political priorities Different economic developments across countries Differences in decision-making rules on including health care programmes in the basic benefit package

Main reasons for difference in PM and ICD implants crude utilization rate (number of devices/100_000 inhabitants) across 5 European countries, 2008-2012_

	Pacemaker implants
	Austria	England	Germany	Italy	Slovenia
2008	67.3	60.0	87.2	74.3	29.9
2009	66.5	68.9	90.6	74.6	32.7
2010	70.5	75.7	94.5	75.1	31.2
2011	71.0	84.1	96.0	75.8	29.7
2012	72.4	N/A	96.4	77.6	32.7
AGR average growth rate	1.84	11.91	2.54	1.09	2.26