COVID Impact on Cardiac Implantable Eletronic Devices Trends in the Brazilian Public Health System: a Joinpoint Regression Analysis
Author(s)
Miriam A. Marcolino, PhD1, Estela Carneseca, MSc2, Mayara P. Sicchieri, MSc2, Carisi A. Polanczyk, DrPH, ScD, MD3, Karlyse C. Belli, PhD4, RODRIGO ANTONINI RIBEIRO, MSc, ScD, MD1;
1TruEvidence, Porto Alegre, Brazil, 2ProEstat, Ribeirão Preto, Brazil, 3IATS, Porto Alegre, Brazil, 4TruEvidence, São Paulo, Brazil
1TruEvidence, Porto Alegre, Brazil, 2ProEstat, Ribeirão Preto, Brazil, 3IATS, Porto Alegre, Brazil, 4TruEvidence, São Paulo, Brazil
Presentation Documents
OBJECTIVES: Changes in the population profile, preferences, clinical practice, and external events, such as the COVID-19 pandemic, may affect the use of Cardiac implantable electronic devices (CIED). Our objective was to analyze the impact of the pandemic on the CIED implantation trends in the Brazilian Public Health System (SUS).
METHODS: SUS Hospital admission claims data from 2008-2023 with CIED implantation (permanent pacemaker [PM], implantable cardioverter-defibrillator [ICD], and cardiac resynchronization therapy devices [CRT-Pacemaker or CRT-Defibrilator]) were analyzed. Incidence rates (IR) per 100,000 population were adjusted to the European standard population. Joinpoint regression, using Poisson modeling, estimated change points and regression coefficients, with the optimal number of joinpoints determined by the weighted Bayesian Information Criterion (maximum of two points and uncorrelated errors. Annual percentage changes (APC) with 95% confidence interval (CI) were estimated for each segment, comparing average APC (AAPC) between the pre-COVID (2008-2019) and post-COVID (2020-2023) periods.
RESULTS: During the period, 216,927 admissions for CIED implants were reimbursed by SUS. Overall annual IR oscillated from 18.4 to 20.8 implants per 100,000 population, with a significant decline identified after 2012 (APC 2008-2012 2.7, 95%CI -0.3, 10.8, 2012-2023 -1.9, 95%CI -4.1; -1.3). No inflection point was detected with the pandemic start, but the AAPC changed from -0.3 (95%CI -0.9; 0.8) to a significant decline of -1.9 (95%CI -4.0; -1.3) in the 2020-2023 period. CRT-Defibrilator implants presented positive AAPC pre-COVID, with stagnation post-COVID, while PM presented a significant decline post-COVID. CRT-P and ICD trends remained the same pre- and post-COVID.
CONCLUSIONS: The COVID pandemic temporarily disrupted surgical procedures but did not alter the general trend of CIED implantation in Brazil (SUS). Implantation rates were already stagnant pre-pandemic and tended to decrease post-COVID, with no recovery observed across device types, highlighting long-term challenges in maintaining CIED access and utilization in the SUS, urging a better understanding of the reasons.
METHODS: SUS Hospital admission claims data from 2008-2023 with CIED implantation (permanent pacemaker [PM], implantable cardioverter-defibrillator [ICD], and cardiac resynchronization therapy devices [CRT-Pacemaker or CRT-Defibrilator]) were analyzed. Incidence rates (IR) per 100,000 population were adjusted to the European standard population. Joinpoint regression, using Poisson modeling, estimated change points and regression coefficients, with the optimal number of joinpoints determined by the weighted Bayesian Information Criterion (maximum of two points and uncorrelated errors. Annual percentage changes (APC) with 95% confidence interval (CI) were estimated for each segment, comparing average APC (AAPC) between the pre-COVID (2008-2019) and post-COVID (2020-2023) periods.
RESULTS: During the period, 216,927 admissions for CIED implants were reimbursed by SUS. Overall annual IR oscillated from 18.4 to 20.8 implants per 100,000 population, with a significant decline identified after 2012 (APC 2008-2012 2.7, 95%CI -0.3, 10.8, 2012-2023 -1.9, 95%CI -4.1; -1.3). No inflection point was detected with the pandemic start, but the AAPC changed from -0.3 (95%CI -0.9; 0.8) to a significant decline of -1.9 (95%CI -4.0; -1.3) in the 2020-2023 period. CRT-Defibrilator implants presented positive AAPC pre-COVID, with stagnation post-COVID, while PM presented a significant decline post-COVID. CRT-P and ICD trends remained the same pre- and post-COVID.
CONCLUSIONS: The COVID pandemic temporarily disrupted surgical procedures but did not alter the general trend of CIED implantation in Brazil (SUS). Implantation rates were already stagnant pre-pandemic and tended to decrease post-COVID, with no recovery observed across device types, highlighting long-term challenges in maintaining CIED access and utilization in the SUS, urging a better understanding of the reasons.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
RWD27
Topic
Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Infectious Disease (non-vaccine)