Background: With the increasing ageing population, especially in developed countries, the rate of permanent pacemaker (PPM) implantation has increased. The increase in life expectancy associated with the increase in cardiovascular co-morbidities is likely the major contributor to the rising rate of PPM implantation. Over 70% of PPM implantations occur in patients over 65 years of age.1 While many studies around the world have reported the rising rate of PPM implantation, there is no study evaluating the rate of PPM implantation Australia-wide over the last 2 decades.
Aim: This study aims to evaluate the trends in PPM implantation in Australia by year, patient age and sex over the last 19 years.
Method: This was a population-based observational study using the National Hospital Morbidity Database (NHMD) to identify all PPM implantation procedures between July 2000 to June 2019. The NHMD record diagnosis and procedures for all hospitalizations in Australia and these data are aggregated and freely available. The number of PPM implantation procedures by year, patient age (<55, 55–64, 65–74, 75–84, and 85 years or more) and sex were analyzed.
Results: From July 2000 to June 2019, there were 278,355 PPM implantation procedures in Australia. Over 58% of PPM implantation was in men and more than 95% of PPM implantations were in patients over 55 years. Between 2000-2001 and 2018-2019, the annual number of PPM implantation increased from 10,326 to 18,964. The population-adjusted rate increased from 53.7 to 74.8 procedures per 100,000 persons. The number of PPM implantation has increased by 83% over the last 2 decades. The PPM implantation rate was highest for patients aged 85 years and older. In 2018–2019, compared to the population rate of PPM implantation of 74.8 procedures per 100,000 persons; the rate for patients aged 85 years and older was 939.9 procedures per 100,000 persons (Figure 1). Only a small proportion of PPM implantation (4.9%) was performed in people under the age of 55 years. The rate in this age group however decreased between 2000-2001 and 2018-2019 from 4.6 to 3.7 per 100,000 persons.
Conclusion: There has been a steady growth in the use of PPM in Australia over the last 19 years. This is likely because patients are getting older with more medical comorbidities. The rate of PPM implantation in patients younger than 55 years has however decreased over time, likely as a result of improved quality of healthcare. The findings in this study have important implications for future healthcare policy decisions.