Epidemiologic Burden of Hospitalization Among Adult Filipinos for Cardiac Arrhythmias Requiring Permanent Pacemaker Implantation
Authors: Gervacio Giselle G , Pestaño Noemi S , Tumanan-Mendoza Bernadette A , Mendoza Victor L , Punzalan Felix Eduardo R , Santos April Ann A.  Bermudez-delos , Gabriel Eden A , Fadreguilan Erdie C , Agbayani Michael Joseph M , David Gladys Ruth S , Segundo Luigi Pierre S , De Las Llagas Carlos E , Lagamayo Magdalena J 
Published: July 2024

BACKGROUND: Symptomatic bradycardia, commonly attributed to sinus node dysfunction/ sick sinus syndrome, or atrioventricular (AV) blocks or conduction disorders from chronic  fascicular blocks, is treated by implantation of a permanent pacemaker. Despite it being a class  1 recommendation, there is a perception based on informal surveys that permanent pacemaker  implantation (PPI) is underutilized. The Philippines showed slow growth in the volume of  implantation from 1049 in 2015 to 1225 in 2016. The Philippine pacemaker data after 2016 are  incomplete and unreliable because of the lack of a national registry. It is the aim of this study to  ascertain the prevalence of cardiac arrhythmias requiring PPI and the volume of its utilization in the  Philippines. 

OBJECTIVES: The aims of this study were to (1) to determine the prevalence of hospitalization  claims in 2017 and 2018 for cardiac arrhythmias requiring PPI, (2) to determine the regional  distribution of arrhythmias requiring PPI, (3) to determine the regional distribution of hospitalization  claims for PPI, (4) to determine the number of hospitalization claims for specific cases requiring  PPI and the corresponding mortality rate, (5) to determine the number of hospitalization claims for  PPI and the corresponding mortality rate, and (6) to describe the demographic profile of patients  with indications and with claims for PPI, as well as the duration of hospitalization and type of  facilities where the hospital claims were filed. 

METHODS: This is a descriptive study of Filipino patients 19 years or older, admitted for cardiac  arrhythmias requiring PPI in the Philippine Health Insurance Corporation (PhilHealth)–accredited  hospitals in 2017 and 2018. The data for disease prevalence were gathered from the database  of PhilHealth using the International Statistical Classification of Diseases and Related Health  Problems, Tenth Revision (ICD-10) of the World Health Organization. The procedures that the  patients underwent were determined using the latest PhilHealth Relative Value Scale (RVS) codes.  Other variables gathered were the demographic data, diagnosis, region, duration of hospital stay,  type of facility on admission, and the status on discharge. Qualitative data were tabulated and  presented as frequency and percent distribution. Quantitative data were reported as median with  corresponding quartiles (Q1 and Q3). 

RESULTS: Based on the 2017 and 2018 database of PhilHealth, out of the nationwide total  medical admissions, there were 958 total claims for arrhythmias requiring pacemaker implantation  in 2017 and 1144 total claims in 2018. The prevalence in both years was similar (0.04%). There  were 549 and 683 total claims for PPI, in 2017 and 2018, respectively, and preponderantly done  in the National Capital Region. Sick sinus syndrome/tachycardia–bradycardia syndrome had the  greatest number of total claims for both years. More than half of the patients who had PPI were  females. The median age was similar (67 and 68 years old for both years and 73 and 75 years old  in 2017 and 2018, based on ICD-10 and RVS codes, respectively). The duration of hospitalization  was a median of 4 days (ICD-10 codes) and 5 to 6 days (RVS codes). Most of the hospital claims  for cardiac arrhythmias (76%–79%) requiring PPI were filed in private facilities. Mortality among  those diagnosed was 3.6% for complete atrioventricular block and 0.3% for sick sinus syndrome  but was low among those who underwent PPI (0.8%–2.2%).. 

CONCLUSION: The prevalence of hospitalization claims for arrhythmias requiring PPI was  0.04%, both in 2017 and 2018. There is a big gap between the number of cases requiring a  permanent pacemaker and the number that underwent the procedure. Hospitalization claims,  based on ICD-10 codes and RVS codes, were centralized in the National Capital Region and  private hospitals. The mortality rate among those who had the procedure was low. 

KEYWORDS: arrhythmia, permanent pacemaker insertion or implantation, prevalence,  hospitalization, PhilHealth