Temporal trends in CIED procedures and reinterventions in Germany: a nationwide analysis, 2015 to 2019
B J Baldauf, R Vonthein, M Giaccardi, O Assadian, P Chevalier, C H Haddad, K Bode, R Cemin, A Kloess, P W X Foley, H BonnemeierAbstract
Background
Cardiac implantable electronic device (CIED) therapy is increasingly complex, with evolving procedural patterns and patient demographics. Understanding temporal trends in device implantation, revisions, and procedural burden provides insight into healthcare resource utilization and may guide optimization of device management strategies.
Methods
We performed a nationwide observational analysis using de-identified statutory health insurance claims data from the Allgemeine Ortskrankenkassen (AOK) encompassing 26.8 million beneficiaries. CIED procedures, including de novo implants, generator replacements, revisions, and extractions, were identified using German OPS codes (5-377, 5-378, 5-934). Annual trends in procedure counts, patient numbers, age, sex distribution, and procedural multiplicity per patient were assessed between 2015 and 2019 using Poisson and logistic regression models.
Results
Between 2015 and 2019, a total of 403,936 CIED procedures were performed in 282,205 patients. Although the number of patients undergoing CIED procedures declined from 60,296 in 2015 to 51,992 in 2019, the total number of procedures remained relatively stable (78,177 vs. 83,202), indicating an increasing procedural burden per patient. The mean number of procedures per patient rose from 1.30 to 1.60 over the study period. Trends were consistent across device types, including pacemakers, ICDs, and CRT systems. Male patients consistently represented the majority of recipients (~58%), and the median age at hospital admission remained stable around 74 years. Regression analyses revealed a statistically significant increase in procedure multiplicity per patient over time (OR/year >1, p<0.01), suggesting increasing complexity of device therapy and associated interventions.
Conclusions
Despite a declining number of patients receiving CIEDs, procedural intensity per patient has increased nationally in Germany, reflecting rising complexity in device therapy, revisions, and reinterventions. These temporal trends have implications for healthcare resource allocation, procedural planning, and may indirectly inform strategies for infection prevention and device management. Further studies are warranted to explore underlying drivers, including patient comorbidities, device technology, and institutional practices.