Heart Rhythm Society Members’ Views on Pacemaker and Implantable Cardioverter‐Defibrillator Reuse

Abstract

HRS survey respondents support the concept of CIED reuse for patients in LMICs who cannot afford new devices. Studies are needed to demonstrate the clinical efficacy and safety of this practice and to identify potential barriers to adoption among physicians.

Worldwide pacemaker and defibrillator reuse: Systematic review and meta‐analysis of contemporary trials

“…However, it is conservatively estimated that more than 1 million patients who require such device therapy go without treatment annually . Implanting physicians in underserved nations cite device expense as the single greatest barrier to device therapy in their regions . This viewpoint is not surprising as the cost for a new pacemaker pulse generator (approximately $2,500–$8,000 US dollars) or a new defibrillator generator (approximately $10,000–$18,000 US dollars) by itself represents a prohibitive obstacle for most people in low‐ and middle‐income nations.…”

“…Importantly, there have been no subsequent alterations in the restrictive USA, Canadian, and European Union laws regulating what manufacturers label as “single‐use devices” nor medical professional societal recommendations to assist high‐income nations with such humanitarian efforts in low‐ and middle‐income nations . This regulatory climate persists even though 87% of both device patients and device physicians surveyed in the United States are willing to donate their devices postmortem to help indigent patients in other nations . In fact, the majority of American device patients in the modern era die with pacemakers and defibrillators that are functional and have >7 years battery longevity on average .…”

“…Meanwhile, Germany, the Netherlands, and the USA exhibit annual defibrillator implantation rates of >200 per million whereas they remain < 2 per million in Bangladesh, India, and Peru . The greatest barrier for device implantations cited by 90% of physicians from underserved regions is the prohibitive cost of such medical devices for most of their patients . Accordingly, many clinicians have undertaken studies examining the safety and efficacy of pacemaker reuse and, as a result, the protocols for retrieval, resterilization, and reimplantation of pacemakers have been greatly refined over the last four decades …”

“…3 The greatest barrier for device implantations cited by 90% of physicians from underserved regions is the prohibitive cost of such medical devices for most of their patients. 5 Accordingly, many clinicians have undertaken studies examining the safety and efficacy of pacemaker reuse and, as a result, the protocols for retrieval, resterilization, and reimplantation of pacemakers have been greatly refined over the last four decades. [6][7][8][9][10][11] In light of recently published controlled trials, we sought to systematically review the contemporary data made available in the last decade regarding the safety and efficacy of pacemaker, defibrillator, and CRT (herein termed "device") reuse and compare to new device use in underserved nations.…”

Cardiovascular implantable electronic device function and longevity at autopsy: an underestimated resource

“…12 In a recent survey, 90% of Heart Rhythm Society (HRS) physician members (predominantly electrophysiologists) from such underserved nations cited cost as the greatest barrier to CIED therapy. 15 This viewpoint is not surprising as the cost for a pacemaker generator alone (approximately $4000-$10000 in US dollars) or for a defibrillator generator by itself (approximately $14,000-$24,000 in US dollars) represents a prohibitive obstacle for many people in lowincome and lower-middle-income countries.…”