DENVER — Total annual pacemaker implantations in the United States will climb by 50% from the year 2010 level to 2027, while a 50% increase in implantable cardioverter defibrillator placements will occur by 2029, according to new mathematical modeling.
These new projections are based on a constant 2007 device utilization rate with superimposed U.S. Census Bureau forecast demographic trends. The resultant sharp rise in the absolute number of procedures is being driven solely by the nation's aging population demographics, Steven M. Kurtz, Ph.D., explained at the meeting.
“These are conservative assumptions. Right now in our projections the increase is driven by the population mix, not by changes in technology or changes in the indications,” said Dr. Kurtz, research professor of biomedical engineering, science, and health systems at Drexel University, Philadelphia, and corporate vice president at Exponent Inc., an engineering and scientific consulting firm.
Should the indications for device therapy expand in the future, as has occurred for implantable cardioverter defibrillator (ICD) therapy within the past decade, then the projected increase in implantations and associated increase in health care costs “could be of much greater magnitude,” he added.
The projected use of pacemakers and ICDs was constructed by combining 2004-2007 data from the Department of Health and Human Services' Nationwide Inpatient Sample on average procedure rates in various population subgroups with Census Bureau estimates of coming changes in the population. The Nationwide Inpatient Sample is a statistically valid survey of about 1,000 U.S. hospitals that incorporates roughly 20% of all hospital admissions.
Pacemaker removals and revisions are expected to increase from 33,510 procedures this year to 53,121 in 2030, a 59% increase. ICD removals and revisions are anticipated to climb from 8,065 in 2005 to 12,415 in 2030, a 54% rise, according to Dr. Kurtz.
The increase in pacemaker implantations will be greatest in the 65- to 84-year-old age group and it will come at the expense of the very elderly. While 64% of all pacemakers were placed in 65- to 84-year-olds in 2007, this proportion will grow to 83% by 2030. Meanwhile, the proportion of pacemakers implanted in patients aged 85 and up will decline from 25% to 12%.
The proportion of primary ICD implantations in patients aged 65-84 is projected to rise from 56% in 2007 to 68% by 2030, while ICD placement in patients younger than 65 will decline from 39% to 27%.
Disclosures: The study was funded by Medtronic.