Temporal trends of cardiac implantable electronic devices (CIED) implantation in the Brazilian Public Health System: a 12-year real-world data study

Population aging, cardiovascular disease burden, and evolving clinical practices may influence procedure rates, key to health policy planning. This study aimed to describe cardiac implantable electronic devices (CIED) implantation trends in the Brazilian Universal Health System (SUS) over 12 years. Ecological study using open data on hospital claims (2008-2019) for permanent pacemaker (PM), implantable cardioverter-defibrillator (ICD), and cardiac resynchronization therapy with pacemaker (CRT-P) or defibrillator (CRT-D) implants. Annual percent changes (APC) with 95% confidence interval (CI) were estimated by linear regression of the logarithm of age and sex standardized implantation rates per million (MM) population (Brazil 2019 population). 216,927 CIED implants were analyzed. Annual implant volume rose from 14,466 to 20,726 (+43.3%). Nonetheless, the standardized rate declined from 108.9 to 98.2/MM (-9.8%), with an APC of -1.2% (95%CI -1.7% to -0.7%). PM and ICD rates were stable, but CRT trends diverged (CRT-D increasing, CRT-P decreasing). Regional analyses showed negative trends for PM and CRT-P, and heterogeneous ICD/CRT-D patterns. Despite increasing volume, standardized CIED implantation rates declined in SUS, especially for PM and CRT-P. Divergent regional trends highlight the need for targeted health policies to ensure equitable access to advanced CIED therapies.