Implantable cardioverter–defibrillator therapy in Australia, 2002–2015

Objectives: To quantify the number of implantable cardioverter–defibrillator (ICD) procedures in Australia by year, patient age and sex, and to estimate age group‐specific population rates and the associated costs.

Design, setting: Retrospective observational study; analysis of Australian National Hospital Morbidity Database hospital procedures data.

Participants: Patients with an ICD insertion, replacement, adjustment, or removal procedure code, July 2002 – June 2015.

Main outcome measures: Number of ICD procedures by procedure year, patient age (0–34, 35–69, 70 years or more) and sex; age group‐specific population procedure rates; number of procedures associated with complications.

Results: The number of ICD procedures increased from 1844 in 2002–03 to 6504 in 2014–15; more than 75% of procedures were in men. In 2014–15, the ICD insertion rate for people aged 70 years or more was 78.1 per 100 000 population, 22 per 100 000 for those aged 35–69 years, and 1.40 per 100 000 people under 35. The reported complication rate decreased from 45% in 2002–03 to 19% in 2014–15, partly because of a change in the coding of complications. The number of removals corresponded to at least 4% of the number of insertions each year. The aggregate cost of hospitalisations with an ICD procedure during 2011–14 was $445 644 566.

Conclusion: ICD procedures are becoming more frequent in Australia, particularly in people aged 70 or more. Patterns of care associated with ICD therapy, particularly patient‐ and hospital‐related factors associated with adverse events, should be investigated to better understand and improve patient outcomes.