Epidemiologic burden of hospitalization among adult Filipinos for cardiac arrhythmias requiring permanent pacemaker implantation

Giselle G Gervacio; Noemi S Pestañ; o; Bernadette A Tumanan-mendoza; Victor L Mendoza; Felix Eduardo R Punzalan; April Ann A Bermudez-delos Santos; Eden A Gabriel; Erdie C Fadreguilan; Michael Joseph M Agbayani; Gladys Ruth S David; Luigi Pierre S Segundo; Carlos E De Las Llagas; Magdalena J Lagamayo

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Epidemiologic burden of hospitalization among adult Filipinos for cardiac arrhythmias requiring permanent pacemaker implantation

Author: Giselle G. Gervacio ^{1
,

2
,

3} ; Noemi S. Pestaño ¹ ; Bernadette A. Tumanan-Mendoza ^{1
,

4} ; Victor L. Mendoza ^{5
,

6} ; Felix Eduardo R. Punzalan ^{1
,

2} ; April Ann A. Bermudez-delos Santos ¹ ; Eden A. Gabriel ^{3
,

7} ; Erdie C. Fadreguilan ³ ; Michael Joseph M. Agbayani ^{1
,

2
,

3} ; Gladys Ruth S. David ^{3
,

7} ; Luigi Pierre S. Segundo ⁸ ; Carlos E. De Las Llagas ⁹ ; Magdalena J. Lagamayo ¹⁰
Author Information

1. Section of Cardiology, Department of Internal Medicine, Manila Doctors Hospital
2. Division of Cardiovascular Medicine, Department of Medicine, Philippine General Hospital, University of the Philippines College of Medicine
3. Division of Electrophysiology, Philippine Heart Center
4. Department of Clinical Epidemiology, University of the Philippines College of Medicine
5. Section of Cardiology, Department of Internal Medicine, De La Salle University Medical Center, Dasmarinas, Cavite
6. Department of Physiology, De La Salle Medical and Health Sciences Institute, Dasmarinas, Cavite
7. Cardinal Santos Medical Center
8. The Medical City, Asian Hospital and Medical Center
9. St Lukes Medical Center-Global City, Daniel Mercado Medical Center Tanauan City
10. Our Lady of Lourdes Hospital
Publication Type:Journal Article
Keywords: permanent pacemaker insertion; implantation; PhilHealth
MeSH: Arrhythmias, Cardiac; prevalence; Hospitalization
From: Philippine Journal of Cardiology 2021;49(1):21-29
CountryPhilippines
Language:English
Abstract: 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.
Full text:202410210813195629321_PJC Jan Jun 2021.pdf