Buzon ML, Briones E, Villegas R, Martinez F, Hermosilla T, Corbacho B, Marquez S; Health Technology Assessment International. Meeting (2nd : 2005 : Rome, Italy).
Ital J Public Health. 2005; 2: 289.
Andalusian Agency For Health Technology Assessment, Avda. de la Innovación, s/n Edif. Arena-1, Sevilla, Andalusia, 41020 Spain Tel: 34955006214, Fax: 34955006677, E-mail: marial.buzon.ext@juntadeandalucia.es
Objectives: The decision to implant a permanent pacemaker varies in different clinical scenarios and there may be difficult trade-offs between health benefits and risks. This study aims to assess the variability and the appropriateness of clinical practice in this field in Andalusian public hospitals. Methods: A random sample of 1424 cases of patients who underwent pacemaker implantation over the period 1998-2000, was selected and information obtained from clinical files. An expert panel according to the RAND-UCLA method provided the appropriate, uncertain, or inappropriate ratings of indications for clinical miniscenarios, classified in ten different chapters. It was formulated and analysed a logistic regression model in order to identify the relation between the appropriateness of use and the independent variables. Results: Overall, 62.3% of patients were rated as appropriate, 25.1% uncertain and 12.6% inappropriate. The chapters with the higher rates of inappropriateness were first degree AV block (17%) and Sinus node dysfunction (24%). There were no significant differences in inappropriateness according to hospital size. The largest inappropriateness was found in age group below 55 (19.7%). The patients with worst prognosis, were the most inappropriate. DDD-DDDR (36.2%) and VVI-VVIR (36.8%) were the devices more frequently used, with rates 14% and 16% of inappropriateness, respectively. Conclusions: The present study shows important differences in appropriateness of implantation of pacemaker according to age, type of hospital and clinical departments. The multivariant analysis showed that the age and sex do not show significant difference, being the hospital, the clinical departments and the index of charlson the factors that explain to a greater extent. Although the proportion of pacemakers implanted in patients with bad prognosis was low, most of then were rated as inappropriate.
Publication Types:
Keywords:
- Heart Block
- Hospitals
- Hospitals, Public
- Humans
- Logistic Models
- Pacemaker, Artificial
- Spain
- hsrmtgs
UI: 103141231
From Meeting Abstracts