PM and ICD trends during COVID-19 pandemic in Italy. A global analysis of the national hospital discharge database

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Italian Minister of Health. BACKGROUND: At the beginning of the COVID-19 emergency, important restrictions in hospital admissions for non-urgent procedures, to reduce the spread of the epidemic and to direct resources for the management of patients affected by the SARS-COV2 virus were required. Furthermore, in the same period there was a significant reduction of admissions for cardiological emergencies, too. The nationwide impact of COVID-19 pandemic on invasive procedures, such Pacemakers (PM) and Implantable Cardioverter-Defibrillators (ICD) interventions, is unknown. PURPOSE: To evaluate the trend of PM and ICD procedures performed in Italy in the last 10 years and particularly in the pandemic period. METHODS: All the Italian Hospital Discharge Records (Schede di Dimissione Ospedaliera – SDO) from 2012 to 2021, sent by the Italian Ministry of Health to the National Institute of Health (NIH, Istituto Superiore di Sanità-ISS) were reviewed. Among these, only records including ICD or PM procedures, either primary or secondary, and correctly reporting patient’s age and gender, were selected. The ICD9-CM codes, single and combined, relating to PM and ICD procedures were selected a taxonomy arranged into 16 groups of procedures was defined. PM procedures were also divided in 1°implant and replacement, while ICD could be considered as total procedures only. RESULTS: From 2012 to 2019 the yearly number of total PM procedures was quite stable, ranging from 63.498 (1.069/million inhabitants) to 68.807 (1.150/million). In 2020, a reduction of total procedures (38.411, 1078/million, -11% towards 2019) and 1st implant of PM (from 52.216 to 43.962, -16%), but not PM replacement, (from 16.591 to 17.331, +4%) was observed; at beginning of pandemic period (April 2020), the drop in total PM procedures in comparison to the 2018 and 2019 average value was 49%. In 2021, an increase to values exceeding the pre-pandemic numbers, was observed (total procedures 69.330, 1170/million, 49.555 1° implants, 19.775 replacements). For ICD, a slow increase of the procedure rate was observed from 2012 (20.774, 350/million) to 2017, 24.255, 400/million); afterwards, a small reduction of implants was observed in 2018 (22.616, 378/million) and 2020 (22.355, 375/million). The drop in ICD procedures observed in April 2020, compared to the 2018 and 2019 average value, was 46%. In 2021 the rate of ICD procedures (25.384, 429/million) increased more than to the pre-pandemic values. No significant changes in PM and ICD indications were observed during the study interval. CONCLUSIONS: During the first year of COVID-19 pandemic, a reduction of PM and ICD procedures was observed, especially in the first period (April 2020); for PM, no reduction of replacements was observed in 2020, while the reduction of 1° PM implant and ICD procedures was compensated by an increase of activity in 2021.