ObjectivesTo determine contemporary population estimates of the prevalence of cardiac permanent pacemaker (PPM) insertions.MethodsA population-based observational study using linked hospital morbidity and death registry data from Western Australia (WA) to identify all incident cases of PPM insertion for adults aged 18 years or older. Prevalence rates were calculated by age and sex for the years 1995–2009 for the WA population.ResultsThere were 9782 PPMs inserted during 1995–2009. Prevalence rose across the study period, exceeding 1 in 50 among people aged 75 or older from 2005. This was underpinned by incidence rates which rose with age, being highest in those 85 years or older; over 500/100 000 for men throughout, and over 200/100 000 for women. Rates for patients over 75 were more than double the rates for those aged 65–74 years. Women were around 40% of cases overall. The use of dual-chamber and triple-chamber pacing increased across the study period. A cardiac resynchronisation defibrillator was implanted for 58% of patients treated with cardiac resynchronisation therapy.ConclusionsRates of insertion and prevalence of PPM continue to rise with the ageing population in WA. As equilibrium has probably not been reached, the demand for pacing services in similarly well-developed economies is likely to continue to grow.

Objective: To determine the validity of the GRACE (Global Registry of Acute Coronary Events) prediction model for death six months after discharge in all forms of acute coronary syndrome in an independent dataset of a community based cohort of patients with acute myocardial infarction (AMI). Design: Independent validation study based on clinical data collected retrospectively for a clinical trial in a community based population and record linkage to administrative databases. Setting: Study conducted among patients from the EFFECT (enhanced feedback for effective cardiac treatment) study from Ontario, Canada. Patients: Randomly selected men and women hospitalised for AMI between 1999 and 2001. Main outcome measure: Discriminatory capacity and calibration of the GRACE prediction model for death within six months of hospital discharge in the contemporaneous EFFECT AMI study population. Results: Post-discharge crude mortality at six months for the EFFECT study patients with AMI was 7.0%. The discriminatory capacity of the GRACE model was good overall (C statistic 0.80) and for patients with ST segment elevation AMI (STEMI) (0.81) and non-STEMI (0.78). Observed and predicted deaths corresponded well in each stratum of risk at six months, although the risk was underestimated by up to 30% in the higher range of scores among patients with non-STEMI. Conclusions: In an independent validation the GRACE risk model had good discriminatory capacity for predicting post-discharge death at six months and was generally well calibrated, suggesting that it is suitable for clinical use in general populations. P atients who have been hospitalised for acute myocardial infarction (AMI) remain at increased risk for cardiovascular death in the year after discharge. In a cohort of 1299 patients Froom et al 1 found the risk for ischaemic events, including death, to be greatest in the first few weeks after AMI, declining rapidly up to 10 weeks and remaining in a steady state thereafter. Similarly, the period for increased risk for death among patients after a percutaneous catheter based intervention (PCI) complicated by a rise in cardiac enzymes is up to four months.2 Risk scores can assist in identifying patients at increased risk for death within six months of discharge, for both patients with ST segment elevation AMI (STEMI) and patients with non-STEMI. 3The GRACE (Global Registry of Acute Coronary Events) study collected information from patients admitted with an acute coronary syndrome (ACS) to 94 hospitals in 14 countries in North and South America, Europe and the United Kingdom, and Australia and New Zealand. Overall 32% of patients were classified as having STEMI, 27% non-STEMI and 41% unstable angina. 4 The data were collected between 1999 and 2002. The GRACE model for calculating the risk for all cause mortality at six months after discharge from hospital among patients across the spectrum of ACS was developed and validated in cohorts from the GRACE registry. 5 The GRACE ACS risk model has also been published as an online risk ca...

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