Abstract 15725: Access to Pacemaker Implantation Amongst Medicare Beneficiaries: Travel Distance and Time to Nearest Clinician

Abstract

Background: Despite being an essential procedure with rising use in the United States, the availability and accessibility of procedural care for a permanent pacemaker are not known. We investigated access to pacemaker implantation among Medicare beneficiaries. Methods: US Medicare physician claims from 2020, and county population characteristic data from AHRQ were used to evaluate the density of providers and beneficiaries across states and counties. For each US zip code, we determined the closest pacemaker implantation center using the haversine formula, then assessed the travel duration for each route using the Google Maps API. Results: There was a median of 5 providers performing pacemaker placement per 100,000 individuals over 65 years across all states, with an IQR of 4.5 to 6. At the county level, only 20% of counties in the US had a center offering transvenous pacemaker implantation, and 4% had a center offering leadless pacemakers. Individuals in metropolitan counties drove a median 29 (IQR 18 - 47) minutes to reach a center for pacemaker implantation, while those in non-metropolitan counties drove a median of 72 (IQR 52 - 102) minutes. In counties where >25% of the population is ≥65 years old, the median drive time to a pacemaker center is 86 (IQR 57 - 126) minutes. Residents of counties with a lower median household income (Spearman’s r = 0.45, p < 0.001) and a higher percentage of residents using public insurance had longer drive time to a pacemaker center (r = 0.23, p < 0.001). Out of the estimated 55,356,000 individuals ≥65 years old in the United States, 20,000,000 (36%) had to drive more than one hour, and 4,383,955 (8%) had to drive more than two hours to a site where a pacemaker implantation procedure is performed. Conclusion: Over one-third of the population in the United States has significant access issues to basic electrophysiologic care, highlighting the need for increased resources and improved accessibility.