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To establish cost as a barrier in installation of a permanent pacemaker (PM) based on the number of days spent on temporary pacemaker (TPM) before the installation of a permanent pacemaker (PPM).
This was a retrospective cross-sectional study from 2008-2012 conducted at National Institute of Cardiovascular diseases in Karachi, Pakistan. Data was obtained for 858 patients who were put on a TPM till their finances were approved for a PPM.
The average number of days patients had to be put on TPM was 11.2 ± 10.4 days. The mean in 2008 was 10.2 ± 7.6 days which improved to 8.8 ± 5.9 days in 2012. In 2008, vvi pacemaker was installed in 79.0% of the patients with ddd in the remaining 21.0%, however in 2012, vvi and ddd were installed in 50% each (p-value=0.011). VVI was the more commonly used PPM in 71.7% of the sample. Majority of the patients (81.7%) in the private ward had the procedure done in less than the average number of days as opposed to only 62% of those in the general ward (p-value=0.001).
A major barrier to installation of a permanent pacemaker in our country is the cost of the procedure. The reduction in waiting days and the increased use of dual chamber PMs are promising results. If these rising trends are maintained, the complications due to prolonged use of TPMs such as DVT and infections can be decreased. In a low to middle income country like Pakistan, this has been achieved by the efforts of the government.