Please login or register to print this page.

ARTICLE CONTRIBUTORS

European Society of Cardiology, Dr Stephen Furniss

KEY WORDS

Clinical Articles, Featured

White Book highlights “enormous underprovision of arrhythmia services in the UK”

The White Book1 released recently by the European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC), highlights “enormous underprovision of arrhythmia services in the UK,” according to co-author Dr Stephen Furniss (President of Heart Rhythm UK). The White Book was launched at EHRA EUROPACE 2013, held recently in Athens, Greece.

“There is enormous underprovision of arrhythmia services in the UK”

Co-author Dr Stephen Furniss (President of Heart Rhythm UK)

Co-author Dr Stephen Furniss (President of Heart Rhythm UK)

Speaking to BJC Arrhythmia Watch, Dr Furniss said: “The EHRA white book has been an important initiative from Europe. It shows that the UK is still falling short compared to much of Europe in device implantation. At Heart Rhythm UK we are working hard with NICOR at improving the National database both in terms of completeness of data and also appropriateness and functionality of the system.”

“Catheter ablation numbers are also expanding slowly and we are already seeing atrial fibrillation and atrial flutter ablations make up more than 50% of the total UK ablation numbers. Important pilots are underway testing new patient reported outcomes for such measures and these will be increasingly important in these times of financial stringency. Sadly there are still vast numbers of patients in the UK who could and should benefit from both devices and ablation but appropriate patients are often not referred. In terms of device therapy there is a problem with education of physicans about indications for devices. AF ablation in all the trials is more effective than drugs but we are currently only ablating about 0.2% of the new patients with AF,” he added.

“Even a tenfold increase in supply will only take us to 2% of the patients who could benefit most. There is enormous underprovision of arrhythmia services in the UK – for years the focus has been on coronary disease but certainly for much of the UK arrhythmias are a much commoner cause of admissions (not necessarily to cardiologists) and of resource usage. For example I still participate in the primary PCI rota in my Trust. During my last weekend on call there were no PPCI’s at all but there were eight admissions with AF!” Dr Furniss concluded.

Pacemaker lead extraction

T 1

Pacemaker units implanted and number of implanting centres

The White Book also contains the first European data on lead extraction. France reported the highest number of lead extractions (2,000) followed by Germany (800) and Poland (520). Several countries reported that no lead extractions had been performed (Iceland, Cyprus, Montenegro, Malta, Armenia).

Every country reports on general statistics to describe its demographics and healthcare system. The proportion of deaths resulting from CVD in 2012 were lowest in Israel (17%), Tunisia (23%), Morocco (23%), France (26%) and the Netherlands (28%) and highest in the Ukraine (65.8%), Bulgaria (63%), Serbia (56%) and the Russian Federation (55.5%).

In 2012 pacemaker implantations were highest in Germany (106,567) and France (62,846) and lowest in Montenegro (143). Germany also had the highest numbers of CRT implantations (17,949) and ICD implantations (26,536) in 2012, followed by Italy (11,900 CRTs and 12,000 ICDs). Iceland had the lowest number of CRT implantations (10) while Macedonia had the lowest number of ICD implantations (15).

The number of ablations performed in 2012 was highest in Germany (38,000) and France (31,000) and lowest in Bosnia & Herzegovina (3), Malta (10) and Cyprus (40).

Professor Fernando Arribas, EHRA White Book coordinator, said: “This is an area of increasing interest because device therapy has now been provided for many years. Device systems depend on the function of the leads which become sick as they get older and should be replaced. This is a growing problem because lead extraction has a significant morbidity and mortality all over the world.”

CRT units implanted and number of implanting centres

CRT units implanted and number of implanting centres

“The impact of catheter ablation on big outcomes such as mortality is less significant but the therapy is very important for treating some arrhythmias that have become an epidemic, for example atrial fibrillation,” he added.

An analysis and graphic presentation of the figures will be published in a dedicated supplement of EHRA’s official journal EP-Europace during the ESC Congress, to be held 31 August – 4 September in Amsterdam, the Netherlands. The analysis will be based on White Book data from 2008 onwards and will include comments from experts in the field.

EHRA president, Professor Angelo Auricchio, said: “This new addition is another landmark in the history of the White Book because it includes the lead extraction data, which no other scientific society has been able to provide. We are pleased with our good collaboration with the national societies and working groups that provided us with this information.”

He added: “The forthcoming EP-Europace supplement will show the trends in electrophysiological activities and implantation of devices in Europe. It will reveal whether the current economic crisis in Europe has led to a decline in the number of device implantations over the last year. This would denote a general reduction in care for patients and a growth in the inequality of access to lifesaving treatments.”

T 1

Loop recorders implanted and number of implanting centres

T 3

ICD units implanted and number of implanting centres

References

1. The EHRA White Book 2013: The Current Status of Cardiac Electrophysiology in ESC Member Countries. Available online at http://media.ne.cision.com/l/rwuftwhm/www.escardio.org/communities/EHRA/publications/Documents/ehra-white-book-2013.pdf

Published on: July 30, 2013

Members Area

Log in or Register now.

 For healthcare professionals only
Learning sky

SEARCH THE SITE

RSS FEED

Subscribe to our RSS feed
home

GET EXCLUSIVE UPDATES

Sign up for our regular email newsletters & be the first to know about fresh articles and site updates.

RECENT COMMENTS

    None Found

ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

You are not logged in

You need to be a member to print this page.
Sign up for free membership, or log in.

You are not logged in

You need to be a member to download PDF's.
Sign up for free membership, or log in.