Pacemaker e defibrillatori impiantabili in Italia: analisi delle schede di dimissione ospedaliera nazionali 2001-2023 con focus sul volume di attività delle strutture e sulla mobilità interregionale

Introduction Pacemakers (PM) and Implantable Cardioverter Defibrillators (ICD) have been widely used over the last decades to treat different cardiac disorders and malfunctioning. The aim of this study is to report the trends of implanted PM and ICD in Italy between 2001 and 2023. Moreover, analyses on hospital activity volumes and interregional mobility were carried out. Materials and methods Implant volumes for PM (first and replacement) and ICD are extracted from the Italian Database of Hospital Discharge Records. Classes for volume of interventions were defined according to the number of procedures yearly performed by the hospitals: very low (<50 procedures); low (51-150); medium (151-250); high (251-450); very high (>450). Interregional mobility was evaluated by dividing the country into: Northwest, Northeast, Center, South and Major Islands. Moreover, an analysis on the quota of patients treated out of the region of residence was reported. Results The number of first PM implants shifted from 36,752 in 2001 to 54,552 in 2023 (+48,4%). The number of implanted ICD increased from 3.161 in 2001 to 25.558 in 2023 (+708,5%), comprising 8,843 ICD CRTD (Cardiac Resynchronization Therapy with a Defibrillator) and 16.715 non-CRTD. The number of procedures performed in high and very high-volume hospitals increased from 18.680 (36,5% of total implants) in 2001 to 67.495 (67,3% of total implants) in 2023. Finally, interregional mobility was low. Conclusions An increase in the use of cardiac implantable devices was observed, as well as in the number of interventions performed in high-volume hospitals. These results highlight the need to implement a national registry to monitor outcomes and patient health.