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Morag Cunningham, Database Coordinator, National Cardiac Device Database

Clinical Articles, Lead Article

Report highlights inequity in UK device implantation

UK heart rhythm patients are among the most under-treated in Europe, according to results from the most recent clinical audit of heart rhythm care published recently by the Heart Rhythm UK (HRUK) Audit Group.1 Insight is urgently needed into why the UK is performing so badly, the report claims.

The Cardiac Rhythm Management: UK National Clinical Audit report tracks treatment with implantable cardiac devices available to patients at risk of major cardiac events.  The provision of arrhythmia care within the UK was found to be uneven, based on the quality of cardiac care services varying between locations. Patients in Dorset were found to be 80% more likely to get the treatment they required than those living in Warwickshire.

Speaking to BJC Arrhythmia Watch Morag Cunningham, Project Manager, said that:

“The principle purpose of the report is to inform on the volume and equity of provision of the major cardiac implantable device therapies – pacemakers for bradycardia (PM), cardioverter defibrillators for cardiac arrest (ICD/CRTd) and cardiac resynchronisation therapy for advanced heart failure (CRTp/CRTd) across the Cardiac networks of England and Wales. This data is further broken down by Primary Care Trust (PCT) within cardiac networks, and by hospital.


Morag Cunningham

“The report opens with an overview of the “big picture” showing the UK continuing to languish near the bottom of the European table of implantation rate for PM and ICD. One bright spot is the implantation of CRT devices, where we are second only to Belgium for CRTp and mid table for CRTd. Clearly the relatively new technology of CRT has been warmly embraced by UK clinicians.

“Using age and sex adjusted data, the report continues to show inequity of provision for all classes of devices across the cardiac networks and PCTs of England and Wales, although overall implant rates show some progress towards the national targets for device implantation set by Heart Rhythm UK (HRUK). This is particularly true for the complex devices (ICD/CRTp/CRTd), but there was a disappointing 0.6% decline in simple pacemaker implantation across the country, thus falling even further behind our major European counterparts.

“Across cardiac networks, the new implantation rate for simple pacemakers varies from 360/million to 690/million. This variation is even more pronounced for the complex devices – a patient is more than four times more likely to get an implantable cardioverter defibrillator fitted if they live in North East London than rural Herefordshire & Worcestershire.

“As well as reporting on numbers of implants, the report has sections looking at specific areas of outcomes and best practice, including pacing mode for sick sinus syndrome (one of the NICE guidelines relating to pacemaker implantation).

“For the first time, the 2010 reports carries additional detailed sections on clinical data associated with CRT implantation, and also some preliminary data on cardiac ablation procedures. The report continues to evolve from a number crunching exercise to a fully developed audit on current practise in cardiac device implantation.”

The report’s authors are keen to hear suggestions for additional content. Morag Cunningham can be reached on 01505 612829, or at


1 Cunningham D, Charles R, Cunningham M, de Lange A.  Cardiac Rhythm Management: UK National Clinical Audit 2010.  HRUK Audit Group 2011.  Available from:

Published on: February 7, 2012

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