The National Audit of Cardiac Rhythm Management (CRM device) audit provides a description of the total implant volume and equity of access to the three main implantable cardiac device types – pacemakers (PM) , the implantable cardioverter defibrillator (ICD), and cardiac resynchronisation therapy (CRT) devices. The CRM audit previously published device implantation rates by health area of the patients in order to support the planning and monitoring of Rhythm services in England and Wales.

These current data provide a comparative measure of device implants within the current health geographies of clinical commissioning groups (CCGs) in England and Local Health Boards (LHB) in Wales, as well as showing change over the three available years within these areas.

Indirectly standardised rate (per million population) of device implants in CCG and LHB areas in England and Wales, 2013/14 to 2015/16. Rates are available for:

  • New implants of pacemakers
  • New implants of ICDs
  • Total implants of CRTs
  • Total implants of high energy devices (ICDs and CRT-D devices)

Device implant data: CRM audit, held by the National Institute for Cardiovascular Outcomes Research (NICOR)
Denominators for age-specific and reference crude rates: Office for National Statistics (ONS), mid year population estimates

In order to compare device implants accross geographical areas, the numbers of device implants were aggregated by either CCGs in England or LHBs in Wales, based on the residence of the patient. Devices were aggregated by year and geography for defined device types.
Rates are age and sex adjusted using the indirect standardisation method. Expected deaths were calculated by multiplying the England & Wales sex- and age-specific implant rates (in 5-year age-bands) by the corresponding sex- and age-specific population for the corresponding year in each geography. The indirectly standardised rates are calculated by dividing the observed numbers of device implants by the expected numbers to create a standardised incidence ratio and the ratio is then multiplied by the England and Wales crude device implant rate to create the rates.
Byar’s method1 gives very accurate approximate confidence intervals for counts based on the assumption of a Poisson distribution. This method is used to show confidence around the indirectly standardised rates.

1 Breslow NE, Day NE. Statistical methods in cancer research, volume II: The design and analysis of cohort studies. Lyon: International Agency for Research on Cancer, World Health Organization; 1987:69

Estimates for geographical areas are based on the patient's postcode of residence. Postcode assignment to a valid health area was over 97% complete for patient details treated at England or Wales hospitals in the CRM audit, so there are a small number of records that have not been mapped to a geographic location.
Where the numbers of devices implanted each year within geographies are less than 6, no rate has been calculated.