Implantation of pacemaker and defibrillator

• There is significant geographical variation in the implantation of pacemakers and defibrillators
• The number of procedures increased by 18% from 2016 to 2023
• 65% of the procedures are performed on men

The number of procedures has increased over the period, from 4,300 in 2016 to 5,050 in 2023. At the same time, the rate per 1,000 inhabitants was stable during the period. The average age for pacemaker or defibrillator implantation was 75 years in 2023. Therefore, the increase in the number of procedures can largely be attributed to an aging population. Male patients accounted for approximately 65 % of the procedures in 2023. About 75% of the procedures are performed within their own health trust, but there are significant differences between the catchment areas.

There is considerable geographical variation in the number of procedures. The catchment areas with the highest rates perform about twice as many procedures per 1,000 inhabitants compared to the catchment areas with the lowest rates, and this variation is therefore classified as unwarranted. The catchment areas for Nord-Trøndelag, St. Olav, Førde, UNN, and Innlandet HF consistently have low rates, while the catchment areas for OUS and Lovisenberg HF consistently have high rates.

Nationally, 75 % of the procedures are regular pacemakers, 14 % are cardiac resynchronization therapy (CRT), and 11 % are implantable cardioverter-defibrillators (ICD). The national rate for regular pacemakers has been stable over the period, the rate for ICDs has decreased, and the rate for CRT has increased over the period except for a decline in the last year.

The analysis is based on activity data from the Norwegian Patient Register (NPR) for somatic specialist health services. The data includes activity in public hospitals and private hospitals that provide publicly funded services. Data from specialists under public funding contracts are not included, as this treatment is only provided in hospitals.

The sample consists of procedures with the codes FPK10A, FPK13A, FPK16A, FPK20A, FPK23A, FPK30A, FPK33A, FPK36A, or FPK40A in hospitals.

The analyses distinguish between regular pacemakers, biventricular pacemakers (CRT, cardiac resynchronization therapy) with or without defibrillator function, and implantable cardioverter-defibrillators (ICD). Regular pacemakers are defined by the procedure codes FPK10A, FPK13A, and FPK16A. Biventricular pacemakers (CRT) are defined by the procedure codes FPK20A, FPK23A, FPK36A, and FPK40A. Defibrillators (ICD) are defined by the procedure codes FPK30A and FPK33A.

Replacement and removal of pacemakers, batteries, or electrodes are not included in this analysis.

Where the patient is treated is divided into two categories:

Own HF, treated at one of the hospitals in the catchment area Other HF, treated at a hospital outside the catchment area

To compare catchment areas and between years, the rates are adjusted for gender and age. The adjustment is made using the direct method with the country's population in 2023 as the reference population.

SKDE is solely responsible for the interpretation and presentation of the data provided by NPR. FHI/NPR is not responsible for analyses or interpretations based on the data.

All of the data used in the charts for this analysis can be downloaded as a CSV file.