The rate of complications among hospital patients after having a cardiac device implanted vary widely depending on where the procedure takes place, according to new research.
Published today in the Annals of Internal Medicine, the study of 174 hospitals across Australia and New Zealand reveals the quality of care people receive may account for the wide variation in the rate of complications after having a cardiovascular implantable electronic device (CIED) insertion.
The study included 81,304 patients who received a new CIED with 65,711 permanent pacemakers and 15,593 implantable cardioverter-defibrillators.
Permanent pacemakers and implantable cardioverter-defibrillators are among the most common and costly devices implanted in hospitals.
“CIED complications are common, with 8.2% of patients implanted with new devices having a major device-related complication within 90 days of their operation,” said the study’s lead author, University of Adelaide’s Dr Isuru Ranasinghe, Senior Cardiologist at the Central Adelaide Local Health Network.
“Serious complications can cause considerable patient harm and add to avoidable deaths and healthcare costs. About 60% of these complications occur after leaving the hospital so many doctors and hospitals may not be fully aware of the complications experienced by patients.”
According to the study, almost 19,000 pacemakers and more than 4,000 defibrillators were implanted in Australia last year, with pacemakers often fitted to elderly people who suffer from bradycardia, where their heart beats too slowly, to prompt their heart to beat at a normal rate.
Cardioverter-defibrillators track a person’s heart rate, and if an abnormal heart rhythm is detected, the device delivers an electric shock to restore the heart rhythm to normal.
Study co-investigator, Associate Professor Anand Ganesan, a Cardiac Electrophysiologist at Flinders Medical Centre, said the study shows routinely reporting hospital complication rates should become the norm to inform clinicians, hospitals and the community.
“We should also invest in strategies proven to reduce these, such as optimising procedural technique, adopting better infection control measures, and managing blood thinning drugs peri-procedure.”
Hospitals should be encouraged to take part in quality improvement activities such as auditing complications and engaging in clinical quality registries to reduce complications over time, Dr Ranasinghe added.