Cost-effective Follow-up of the Patient with a Permanent Pacemaker

Abstract

It has been estimated that more than 500,000 people in the United States have permanent pacing systems, and a recent survey suggests that approximately 100,000 to 120,000 new pacing systems are implanted annually [1,2]. Modern pacing systems are complex, with multiple parameters that can be programmed to optimize pacing function for individual patients. Unfortunately, up to 30 percent of pacing systems are left at settings preset by the manufacturer [2]. In addition, up to 20% of pacing system problems may go unrecognized; and suboptimal pacing system care, such as excessively high stimulation outputs and failure to recognize the presence of a lead with an “alert” status, may be present in an additional 20% of patients [3]. Despite the growing complexity of pacing systems, and necessity for speci~cally trained personnel to evaluate their functions, reimbursement for pacing system follow-up is still based on Medicare standards set in 1984 [4], which are clearly inadequate and inappropriate for newer generation devices [5,6]. This review will focus on the authors’ view of cost-effective follow-up of permanent pacing systems with an emphasis, where data are available, on clinical outcomes. Unfortunately, a paucity of relevant data exists, and much of good practice is based on intuition and prudence.