The influence of the 2020 COVID-19 pandemic on the implantation rates of cardiac implantable electronic devices in Germany: changes between 2020 Q1–Q3 and 2019 Q1–Q3

Abstract

Aim During the early phase of the COVID-19 pandemic, hospital admissions for several medical and surgical conditions have declined. Few data are available with respect to elective cardiac implantable electronic devices (CIEDs) implantation. The aim of the present study was to determine the impact of the COVID-19 pandemic on the monthly CIED implantation rates in Germany. Methods and Results The monthly rates of CIED implantation for the 2019 pre- and 2020 pandemic periods were retrieved from the “Institute für das Entgeltsystem im Krankenhaus” (InEK) using OPS codes to identify pacemakers (PMs), implantable cardioverter/defibrillators (ICDs) and cardiac resynchronisation therapy (CRT) systems. Compared with 2019, the COVID-19 pandemic was associated with an overall decline of CIED implantation rates of -2.6%, reaching -22,9% in April 2020. Stratified by device type, the patterns of implantation were similar between PMs and ICDs, with maximal declines of -24.3% and -23.2% in April, respectively. Thereafter, the implantation rates gradually increased before stabilizing to rates similar to those observed in 2019. CRT implantation rates also declined in the early pandemic wave, but the overall 2020 rates increased by +4.3% likely driven by an increase of +16.5% (June to September). All observed percentage differences of monthly device type related implantation rates demonstrated a statistical significance. Conclusions The COVID-19 pandemic had a significant impact on the implantation of CIEDs in Germany. A differential pattern of resource utilization was observed with a catch-up effect for PMs and ICDs. The implantation rates of CRT also declined, but they increased rapidly and remained higher than those of 2019.

A global analysis of implants and replacements of pacemakers and cardioverter-defibrillators before, during, and after the COVID-19 pandemic in Italy

“…Also in Germany, these trends were confirmed, with a drop in CRT-Ds similar to that observed by our study [ 15 ].…”

Impact of the COVID-19 pandemic on cardiac implantable electronic device implantation in China: Insights from 2 years of changing pandemic conditions

“…During the early phase of the COVID-19 pandemic, CIED implantations decreased by 56.5% in northeastern Spain ( 9 ), 39.38% in Poland ( 12 ), 28% in the Veneto region of Italy ( 10 ), and 48% in northwestern Greece ( 13 ). In agreement with these reports, the number of CIED implantations in China also decreased significantly in 2020.…”

“…Additionally, cardiology societies have issued guidelines recommending the postponement or cancellation of any non-urgent elective procedures to conserve healthcare resources, including the placement of cardiac implantable electronic devices (CIED) (7). Focusing on the early stages of the outbreak, studies from several countries have reported a substantial reduction in the number of cardiac interventions (8)(9)(10)(11)(12)(13)(14)(15)(16). However, the survival benefits of CIED implantation have been clearly established (17), and delayed implantation may lead to poor patient outcomes.…”

Cardiovascular disease and COVID-19, a deadly combination: A review about direct and indirect impact of a pandemic

“…A German study showed that the pandemic was associated with an overall decline of device implantation rates of -2.6%, with a peak of almost -23%[ 61 ]. This situation was limited in time.…”