Dysrhythmia and new tech impacting your electrophysiology program

How will the increasing prevalence of dysrhythmia and new technologies impact your electrophysiology program?

Key components and success factors

Dysrhythmia, also known as arrhythmia, refers to heart rhythm disorders that can be caused by factors such as age, obesity, blood pressure, prior heart attacks/failure and chronic lung disease that cause structural damage that alters the conduction pathways. Heart arrhythmias may be managed with medications, catheter procedures, implanted devices or surgery.

Sg2, a Vizient company, is predicting a 10-year total growth rate in the U.S. dysrhythmia market of 2% for inpatient, but a substantial 32% increase for outpatient volumes¹ (Figure 1). The vast majority of outpatient device implants and ablation procedures will continue to be performed on the hospital campus near term for access to high-acuity resources.

Figure 1. Dysrhythmia forecast

US Market, 2022–2032

Note: Analysis excludes 0–17 age group. AF = atrial fibrillation; AP = advanced practitioner; CHF = congestive heart failure; E&M = evaluation and management;
EP = electrophysiology; ICD = implantable cardioverter defibrillator; TAVR = transcatheter aortic valve replacement. Sources: Forrest JK et al. J Am Coll Cardiol. 2022;79:882–896; Impact of Change®, 2022; HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP) 2019. Agency for Healthcare Research and Quality, Rockville, MD; Proprietary Sg2 All-Payer Claims Data Set, 2019; The following 2019 CMS Limited Data Sets (LDS): Carrier, Denominator, Home Health Agency, Hospice, Outpatient, Skilled Nursing Facility; Claritas Pop-Facts®, 2022; Sg2 Analysis, 2022.

Atrial fibrillation (AFib) is the most common arrhythmia and is estimated to impact over 12 million people in the U.S. by 2030.² AFib death rate as the primary or a contributing cause of death has also been on the rise for over two decades.²

Patients with cardiovascular comorbidities are at risk for developing AFib, a trend that will continue to challenge organizations that have not optimized care. The link between AFib and congestive heart failure (CHF) cannot be overlooked, as almost 40% of patients with AFib go on to develop CHF and vice versa.¹ Additional complications may occur in these individuals including stroke, dementia, and increased falls.³

Going forward, health systems will need to think differently in order to effectively manage this complex population as prevalence grows, clinician shortages loom and enhanced diagnosis via wearable devices uncovers more disease.

Advancements in arrhythmia patient care through innovation and technology

Recent innovations have allowed for improved diagnosis, treatment and management of many types of arrhythmias. Additionally, evolutionary changes continue to occur with traditional electrophysiology devices and procedures, and several novel and impactful technologies are poised to disrupt current electrophysiology (EP) practice, such as pulsed field ablation. The public’s awareness of heart rhythm disorders is also growing due to the availability of wearable device technology that can indicate clinically relevant asymptomatic arrhythmias.

"With all of the different and emerging technologies available in remote home monitoring diagnostics, being able to share physiological data across cardiovascular service lines allows organizations - through multidisciplinary teams - to deliver a higher standard of care for patients with multiple comorbidities,” said Jesse Pestilos, consulting director for Vizient, who spent 10 years in electrophysiology operations management within the cardiovascular service line.

Newer direct oral anticoagulants (DOACs), wearable technologies, left atrial appendage closure devices and enhanced ablation modalities and techniques- all of which require physician and administrator collaboration for effective and appropriate implementation- present both challenges and opportunities.

The combined impact of these factors fuels the need for redesigned care models to adequately meet demand - with enhanced care coordination across multiple provider types, including cardiologists, primary care providers, heart failure specialists and electrophysiologists.

Keys to building a comprehensive electrophysiology program

Based on the growing prevalence of arrythmias in the U.S., providers will need to manage care delivery differently to serve the complex needs of these patients as efficiently as possible. Vizient recommends the following:

Dedicated lab for EP procedures

The most common procedures for EP programs are pacemaker and implantable cardioverter defibrillator implantation and intracardiac catheter ablation. Managing the range of procedure types and technology needs for each case can be challenging. A key component of a robust EP program is a devoted/hybrid lab – and dedicated staff - for EP procedures. Complex intracardiac catheter ablations can take four or more hours, whereas device implants can be completed in less than one hour. A dedicated lab helps control wait times for scheduling procedures, enhances staff efficiency and maximizes the advanced imaging and electrical mapping technology necessary to perform EP procedures.

Staffing according to industry guidelines (2019 update)

The Heart Rhythm Society suggests that staffing levels be based on the complexity of the case. Therefore, recommended staffing is determined according to the abilities of your workforce (whether specialized or cross trained) and the specific case mix for that lab. EP clinics have traditionally been constrained by the limited number of EP physicians in practice who represent the smallest of the cardiovascular subspecialties. There is an average of one EP for every 127,500 people in the U.S., and they are not distributed evenly across the nation.⁴