PM and ICD trends during COVID-19 pandemic in Italy. A global analysis of the national hospital discharge database
Authors: Zecchin M , Ciminello E , Torre M , Carrani E , Sampaolo L , Proclemer A , Boriani G , Zanotto G , D'onofrio A , De Ponti R , Sinagra G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Italian Minister of Health.

Background
At the beginning of the COVID-19 emergency, important restrictions in hospital admissions for non-urgent procedures, to reduce the spread of the epidemic and to direct resources for the management of patients affected by the SARS-COV2 virus were required. Furthermore, in the same period there was a significant reduction of admissions for cardiological emergencies, too. The nationwide impact of COVID-19 pandemic on invasive procedures, such Pacemakers (PM) and Implantable Cardioverter-Defibrillators (ICD) interventions, is unknown.

Purpose
To evaluate the trend of PM and ICD procedures performed in Italy in the last 10 years and particularly in the pandemic period.

Methods
All the Italian Hospital Discharge Records (Schede di Dimissione Ospedaliera – SDO) from 2012 to 2021, sent by the Italian Ministry of Health to the National Institute of Health (NIH, Istituto Superiore di Sanità-ISS) were reviewed. Among these, only records including ICD or PM procedures, either primary or secondary, and correctly reporting patient’s age and gender, were selected. The ICD9-CM codes, single and combined, relating to PM and ICD procedures were selected a taxonomy arranged into 16 groups of procedures was defined. PM procedures were also divided in 1°implant and replacement, while ICD could be considered as total procedures only.

Results
From 2012 to 2019 the yearly number of total PM procedures was quite stable, ranging from 63.498 (1.069/million inhabitants) to 68.807 (1.150/million). In 2020, a reduction of total procedures (38.411, 1078/million, -11% towards 2019) and 1st implant of PM (from 52.216 to 43.962, -16%), but not PM replacement, (from 16.591 to 17.331, +4%) was observed; at beginning of pandemic period (April 2020), the drop in total PM procedures in comparison to the 2018 and 2019 average value was 49%. In 2021, an increase to values exceeding the pre-pandemic numbers, was observed (total procedures 69.330, 1170/million, 49.555 1° implants, 19.775 replacements).
For ICD, a slow increase of the procedure rate was observed from 2012 (20.774, 350/million) to 2017, 24.255, 400/million); afterwards, a small reduction of implants was observed in 2018 (22.616, 378/million) and 2020 (22.355, 375/million). The drop in ICD procedures observed in April 2020, compared to the 2018 and 2019 average value, was 46%. In 2021 the rate of ICD procedures (25.384, 429/million) increased more than to the pre-pandemic values.
No significant changes in PM and ICD indications were observed during the study interval.

Conclusions
During the first year of COVID-19 pandemic, a reduction of PM and ICD procedures was observed, especially in the first period (April 2020); for PM, no reduction of replacements was observed in 2020, while the reduction of 1° PM implant and ICD procedures was compensated by an increase of activity in 2021.