Implantable cardioverter-defibrillator therapy in Australia, 2002-2015.

OBJECTIVES: To quantify the number of implantable cardioverter-defibrillator (ICD) procedures in Australia by year, patient age and sex, and to estimate age group-specific population rates and the associated costs. Design, setting: Retrospective observational study; analysis of Australian National Hospital Morbidity Database hospital procedures data. PARTICIPANTS: Patients with an ICD insertion, replacement, adjustment, or removal procedure code, July 2002 - June 2015. MAIN OUTCOME MEASURES: Number of ICD procedures by procedure year, patient age (0-34, 35-69, 70 years or more) and sex; age group-specific population procedure rates; number of procedures associated with complications. RESULTS: The number of ICD procedures increased from 1844 in 2002-03 to 6504 in 2014-15; more than 75% of procedures were in men. In 2014-15, the ICD insertion rate for people aged 70 years or more was 78.1 per 100 000 population, 22 per 100 000 for those aged 35-69 years, and 1.40 per 100 000 people under 35. The reported complication rate decreased from 45% in 2002-03 to 19% in 2014-15, partly because of a change in the coding of complications. The number of removals corresponded to at least 4% of the number of insertions each year. The aggregate cost of hospitalisations with an ICD procedure during 2011-14 was $445 644 566. CONCLUSION: ICD procedures are becoming more frequent in Australia, particularly in people aged 70 or more. Patterns of care associated with ICD therapy, particularly patient- and hospital-related factors associated with adverse events, should be investigated to better understand and improve patient outcomes.

Primary care presentations at emergency departments: rates and reasons by age and sex.

Primary care presentations at emergency departments (EDs) have been the subject of much attention in recent years. This paper is a demographic analysis using administrative data from the Emergency Department Information System (EDIS) for 2005 of such presentations in New South Wales EDs and of self-reported reasons for presentation. Age and sex differences in the reasons given by patients for such presentations are analysed using data from a survey of patients conducted in a subset of EDs in 2004. The rate of "potential primary care" presentations varies greatly with age and to a lesser extent with sex. Almost half (47%) of these presentations are made by people under 25 years of age. Children aged 0-4 years account for 14% of the total. The pattern is distinctly different to the corresponding rate of ED presentations that do not fit the "potential primary care" definition. Reasons given for "potential primary care" presentations are consistent across all age groups, reflecting self-assessed urgency, access to diagnostics and self-assessed complexity. Older "primary care" patients are particularly unlikely to give reasons associated with GP affordability or availability for their presentations. Young adults' responses are consistent with the overall population, and children under the age of five seem most susceptible to availability issues.