|
|
US Hospital Survey of Pacemaker Usage Yields Unexpected Results: New ECRI Institute Evidence Report Finds Dual-Chamber Pacemakers Clinically Superior
The fact that a medical technology has been in use for a long time does not mean that all the important clinical questions about its use have been resolved. The use of cardiac pacemakers is a case in point. When ECRI Institute, an independent health services research agency, surveyed its U.S. hospital subscribers regarding their use of single- and dual-chamber pacemakers, the results were unexpected. It showed that the pacemaker type that hospitals implanted (single or dual) varied for reasons that seemed unrelated to patient indications or clinical characteristics. Furthermore, ECRI Institute expected to find that teaching hospitals, which typically treat more complicated cases, implanted more dual-chamber pacemakers than community hospitals did in their patients. However, survey results showed that a higher number of implants in the teaching hospitals were of single-chamber models
These unexpected findings, coupled with ongoing questions from hospitals about which pacemakers to use, led ECRI Institute to conduct a systematic review of published evidence on pacemakers to ascertain which type of pacemaker to use in order to achieve the best patient outcomes. ECRI Institute published its systematic review as a Windows on Medical TechnologyT evidence report in March 2005: "Dual-Chamber versus Single-Chamber Pacemakers for Sinus Node Dysfunction and Atrioventricular Block."
Each year, about half a million Americans receive pacemaker implants to regulate abnormally slow or fast heartbeat. These electronic devices are mostly used to treat abnormally slow heartbeat rhythms, or bradycardias, which, if untreated, cause symptoms such as fatigue, weakness, dizziness, fainting, and sometimes death. Bradycardias are most often caused by sinus node dysfunction (SND) and atrioventricular (AV) block.
Drawing from an evidence base of 32 trials that enrolled more than 5,500 patients with these conditions, ECRI Institute pooled data to perform various meta-analyses. They concluded that dual-chamber pacemakers, which pace both the ventricles (lower chambers) and the atria (upper chambers) of the heart, are more clinically beneficial and cost-effective compared to single-chamber models, which pace only the ventricles. Analysts found that dual-chamber pacing reduces symptoms of pacemaker syndrome, which causes dizziness and fatigue when the pacemaker attempts to pump against a closed valve.
The evidence report discusses risks and benefits associated with switching patients from single-chamber pacing to dual-chamber pacing. However, analysts found that dual-chamber pacing is not necessarily superior to single-chamber pacing relative to improvement in cardiovascular functional status. Also, some evidence showed that dual-chamber pacemakers have more mechanical problems, although these are generally minor. ECRI Institute recommends, while dual-chamber pacing leads to more clinically significant benefits, that practitioners carefully weigh their options prior to implant.
ECRI Institute's Health Technology Assessment Information ServiceT(HTAIS) provides broad access to technology assessment information and research results to provide objective information to organizations and government agencies that make decisions about the use of medical devices, drugs, procedures, and healthcare services. ECRI Institute evaluates technologies along the continuum of evidence from research and development into wide utilization. As evidence accumulates about healthcare technologies and services, ECRI Institute analyzes the available data to produce various types of evidence reports. ECRI Institute's Windows on Medical Technology reports are systematic reviews of technologies in wide use that have a considerable body of evidence, but still have unresolved key clinical questions about their optimal use. Using meta-analytic techniques, ECRI Institute pools data from many studies to answer questions that could not be resolved by looking at individual studies. ECRI Institute's HTAIS memberships give Trusts, Health Authorities and government agencies the information they need to make informed and strategic decisions about the healthcare technologies and services in use today and those they need to plan for tomorrow.
HTAIS members receive Windows on Medical TechnologyT reports as part of their custom membership benefits; nonmembers may purchase copies of these reports separately. To purchase, please contact info@ecri.org.uk.
Request more information
|
