Abstract P96: Pacemaker Reutilization is a Safe and Effective Means of Delivering Electrophysiological Healthcare in Third World Countries a Meta-Analysis

Abstract

Background: The inequality of healthcare between rich and poor countries appears to be escalating. Several small studies have suggested that pacemaker reutilization is an effective means of delivering healthcare for those with limited resources. This meta-analysis sought to evaluate the safety and efficacy of pacemaker reuse. Methods: We searched medical databases from January 1 st 1975 to July 1 st 2009 for studies that compared pacemaker reuse with a control population of new device implantation. Random-effects models were used to calculate summary odds ratios (OR). The primary endpoint was overall complication rate. Results: A total of 4 trials enrolling 603 subjects were integrated into this analysis. Compared to new pacemaker implantation, reutilization of previously implanted devices were not associated with a significant increase in overall complications (OR 0.98 [0.64 - 1.49]; p= 0.914). Furthermore, there was no increased risk of infection (OR 0.81 [0.41 - 1.62]; p=0.552), physiological complications (OR 1.06 [0.54 - 2.07]; p= 0.868), or device malfunction (OR 1.29 [0.51 - 3.29]; p=0.590). Device-related deaths were observed in neither group. Conclusions: Pacemaker reutilization, when compared to new device implantation, is not associated with higher rates of infection, physiological malfunction, or device malfunction. Pacemaker reuse is a safe, efficacious, and ethical alternative to address the medical needs for those in 3 rd world countries who could not afford therapy otherwise.