Need for implantable cardioverter-defibrillators in the Russian Federation
Objective. To evaluate the number of patients requiring implantable cardioverter-defibrillators in the Russian Federation for diseases associated with sudden cardiac death (SCD). Material and methods. The methods of mathematical modeling were used to assess the need for implantable cardioverter-defibrillators and determine the target population of patients over 18 years old in the Russian Federation. The study comprised 2 stages: assessment of morbidity considering the actual number of admissions for diseases associated with a high risk of SCD in 2019; analysis of the recommended incidence of cardioverter-defibrillator implantation using the expert method and assessment of the need for implantation in accordance with modeling conditions. The need for implantable cardioverter-defibrillator was assessed depending on age, disease associated with a high risk of SCD and the type of device. Results. Total incidence of diseases associated with a risk of SCD among the population over 18 years old was 277.8 people per 100 000. The total number of patients requiring implantable cardioverter-defibrillator in 2019 was 86.316, 47.9% of them need implantation of single-chamber device, 46.3% - two-chamber device, 5.8% - three-chamber device. This result is a one-time value reflecting the total number of patients requiring implantable device in the Russian Federation. Conclusion. The need for implantable cardioverter-defibrillators in the Russian Federation exceeds the actual number of implantations for all types of devices (one-, two-, three-chamber). There is a slight positive trend in the Russian Federation. Indeed, there were about 2000 implantations in 2014 (12.3 per 1 000 000). In 2019, this value was 2 841 implantations. However, higher volume of this type of medical care is required. Currently, implantation of cardioverter-defibrillators is funded through the high-tech medical care that is not included in the basic compulsory health insurance program. This aspect decreases availability of medical care. Therefore, higher accessibility of this care is possible, for example, by changing financial support.