US Pharm. 2014;39(2):74.
Medical devices represent a relatively small share of national health
care dollars (~$200 billion). In 2010, 7.454 million (242.2 per 10,000
population) inpatient cardiovascular (CV) procedures were performed; of
these, 58% took place in male patients (284.8 per 10,000 population).
CV-system operations performed during short-stay hospitalization were
28.5% more common in patients aged ≥65 years than in those aged 45 to 64
years. Operations on vessels of the heart declined notably between 2000
(41.2 per 10,000 population) and 2010 (33.1 per 10,000 population),
with the largest decrease (24%) observed among female patients.
Cardiac Catheterization: This was the most frequent
(33.4 per 10,000 population) of all procedures performed on the CV
system. It was performed predominantly in male patients (62%) and in
those aged ≥65 years (123.8 per 10,000 population). Cardiac
catheterization was generally followed by interventional or therapeutic
procedures to open blocked arteries—e.g., atherectomy, stent placement,
grafting, or pacemaker implantation.
Coronary Atherectomy: This was the second most common
procedure (16.2 per 10,000 population) performed on the CV system.
Two-thirds of patients undergoing the procedure were male. More than
twice the number of ballooning procedures were performed in cardiac
patients aged ≥65 years (63.4 per 10,000 population) than in those aged
45 to 64 years. A new coronary atherectomy system, the Diamondback-360,
is the first in more than 20 years to be FDA-approved to treat severely
calcified lesions. Fifteen percent of patients needing an angioplasty to
treat a heart blockage have severely abnormal levels of arterial
calcium that would benefit from this new device.
Coronary Artery Stent: This was the third most
frequent (0.454 million) procedure performed on the CV system. Stent
recipients were predominantly male (68%). The number of recipients aged
45 to 64 years was one-tenth that of patients aged ≥65 years (75.3 per
10,000 population). Drug-eluting stents were used in 73% of all coronary
artery stent insertions.
Coronary Artery Bypass Graft: This was by far
the most frequently performed procedure in male patients (75%). With
progression of age to ≥85 years, the number of grafting procedures in
patients aged 65 to 84 years rose from 77% to 84% by 2010.
Pacemaker: Therapy was broadened to include
prophylactic pacing for pre–heart block syndrome. The dual-chamber
pacemaker was the type most frequently used, followed by
single-ventricular, single-atrial, and biventricular devices. Although
nearly equal numbers of insertion, removal, and revision of pacemaker
leads or devices were performed in male and female patients, it was the
least common (12 per 10,000 population) procedure performed on the CV
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