Cardiology registrars and permanent pacemaker complication rates in a district general hospital—safety and service implications

Abstract

Permanent cardiac pacing in the district general hospital (DGH) was endorsed by the British cardiovascular society in 1987, and by 1992 a third of DGHs provided this service.1,2 More than two decades have passed and the rates at which permanent pacemakers (PPM) are being implanted have risen substantially. Implant rates in England have increased by approximately 4% per year since 2000 to 525 PPM per million persons in 2011, but our implant rates are still much lower than those of several of our European neighbours.3 An ageing population, greater recognition of pacing indications, and the expansion of the service for local convenience are some of the reasons for the rising implantation rates. With such increasing numbers, and newer devices and leads, it is important to get an updated perspective on the complication rates so that patients are given the correct information when they are consented. Unfortunately, beyond the data published over ten years ago from the large centre trials,4–8 there is only one recently published report from a UK DGH.9 In addition to this, the current structure of specialty training in cardiology leads to most junior registrars acquiring their first experience of device implantation in the DGH. There is evidence that suggests that inexperience is positively correlated with complication rates in the short and long term.10 Yet, there are no published data demonstrating the impact that registrar training has on patient safety and service provision in the DGH. This prospective study, carried out over four and a half years, provides an update on the complication rates of pacemaker implantation in the DGH, and we compare this with other studies in the literature. This study also adds novel prospectively collected data to the literature on registrar complication rates and provides information on the impact that current training arrangements have on service provision.