The impact of NICE (UK) recommendations on outcomes of cardiac pacemaker implantations - a single-centre, district hospital experience

Aims The National Institute for Health and Clinical Excellence (NICE) recommends the use of dual-chamber pacemakers for all patients with bradycardia with a few exceptions. We aimed to evaluate our compliance to the guidelines and the implications of different pacing modalities on follow-up outcomes. Methods We conducted two retrospective studies involving a total of 316 patients. The first study conducted over a 36-month period examined our performance prior to the introduction of the NICE guidance. The more recent second study conducted over a 12-month period examined our compliance to the NICE guidance upon its introduction and adoption. Data were analysed in separate groups according to pacemaker types. Symptom control and mortality were measures on follow-up outcomes. Results Our compliance to the guidance increased from 72% in the former study to 78% in the latter study (P = 0.17). Symptom control and mortality were not significantly different between the two studies. Combining both studies, fewer NICE-compliant patients complained of persisting symptoms after 1 year (P = 0.36). Although fewer deaths were observed in the compliant group, this again was not statistically significant (P = 0.10). Although age was not a criteria in selecting a device, younger patients were more likely to receive a pacemaker according to NICE recommendations (P = 0.001). Conclusions We achieved a near 80% level of compliance to NICE guidance. Our non-NICE-compliant patients did not have a poorer outcome than those who were compliant. The decision to insert single- or dual-chamber pacemakers is often multifactorial and individual doctors may have different practices.