Implant rates of cardiac implantable electrical devices in Europe: a systematic literature review

Cinzia Valzania*, Aleksandra Torbica, Rosanna Tarricone, Francisco Leyva, Giuseppe Boriani

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: In recent years, indications for cardiac implantable electrical devices (CIEDs) have broadened; however, budget constraints can significantly impact patient access to these life-saving health technologies. Objective: To perform a systematic literature review on the implant rates of pacemakers, cardioverter-defibrillators, and cardiac resynchronization therapy devices in Europe over the last decade to provide insight into the possible reasons for differences across regions or countries. Methods: Four electronic databases were searched to find studies describing CIED implant rates in Europe. Fifty-eight studies were included. Results: An overview showed a recent rise in CIED implants, with large geographic differences. The ratio between the regions with the highest and lowest implant rates within the same country ranged between 1.3 and 3.4 for pacemakers and between 1.7 and 44.0 for defibrillators. The ratio between the countries with the highest and lowest implant rates ranged between 2.3 and 87.5 for pacemakers, between 3.1 and 1548.0 for defibrillators, and between 4.1 and 221.0 for resynchronization therapy devices. Implant rate variability appears to be influenced by health care, economic, demographic, and cultural factors. Conclusion: Publications on CIED implant rates in Europe show a wide variability within and across countries, the determinants of which are only partially investigated. Policy making should improve regarding equity of access to better care.

Original languageEnglish
Pages (from-to)1-15
Number of pages15
JournalHealth Policy
Issue number1
Early online date10 Nov 2015
Publication statusPublished - 1 Jan 2016

Bibliographical note

Copyright © 2015 Elsevier Ireland Ltd.

Funding: European Community's Seventh Framework Programme under grant agreement HEALTH-FT3-2012-305694 (Project MEDTECHTA), European Heart Rhythm Association (EHRA).


  • Cardiac resynchronization therapy
  • Implant rates
  • Implantable defibrillator
  • Pacemaker
  • Registries


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