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Independents' Day

Pacemaker lottery sees rates vary 350% between trusts

Provision of pacemakers has been found to vary massively across the UK, with differences in implantation rates of up to 350% between PCTs.

Many clinics are falling short of national guideline standards, with GPs' patients in some cases missing out on pacing or being implanted with an inappropriate device.

Dr Christopher Plummer, consultant in cardiology at Freeman Hospital in Newcastle upon Tyne, said: 'There are large variations in pacing practice in England and Wales that cannot be explained on clinical criteria. Some pacing centres in the UK will need to change practice significantly if they are to follow national guidance.'

His study found many patients were given pacing that was not in line with NICE guidance, with 42% of patients analysed receiving devices recommended for those in continuous atrial fibrillation, when only 24% were actually in atrial fibrillation.

A second study at the same hospital by Dr Janet McComb, consultant in cardiology, found implantation rates ranged from 166 to 745 per million at PCT level.

'There is marked variation in provision of pacing in England, with regional implantation rates varying by up to 350%. There is no obvious reason for this and, in contrast with other cardiac procedures, it is not related to socioeconomic deprivation,' Dr McComb said.

Her study looked at all pacemaker implantation in England between 2003 and 2004, obtaining data on 98% of 40,284 patients.

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