Η εξέλιξη των επεμβατικών θεραπειών των αρρυθμιών στην Ελλάδα Βασίλειος Π. Βασιλικός Καθηγητής Καρδιολογίας ΑΠΘ
Conflict of interest Sponsored by HCS
Current Situation in Greece 61 pacing centers (51 hospitals) 31 ICD implantation centers (27 hospitals) 16 CRT implanting centers 30 Ablation teams (26 hospitals) 7 University Medical facilities 35% of total EP and Pacing
Cardiologists (per million people) Cardiologists per million people & GDP per capita, PPP ($) 300 GRC y = -5,414ln(x) + 139,76 R² = 0,0059 250 GEO 200 BGR 150 EST CYP HUN ITA 100 50 MDA KGZ SRB ALB AZE UKR BIH MKD ROU TUR LVA POL KAZ PRT ESC Average CZE SVK SVN ISR MLT ESP FRA DNK FIN BEL SWE ISL DEU AUT NLD IRL CHE NOR LUX 0 0 10.000 20.000 30.000 40.000 50.000 60.000 70.000 80.000 90.000 100.000 GDP per capita, PPP (US $)
Electrophysiologists (per million people) Electrophysiologists per million people & GDP per capita, PPP ($) 18 16 GRC POL y = 2,587ln(x) - 21,162 R² = 0,122 14 CZE 12 10 SWE ISL 8 6 ESC Average LUX LTU DNK SVK MLT ALB HUN 4 SVN EST NOR LVA ESP MKD CYP 2 PRT MDA BGR SRB AZE ROU BIH 0 0 10.000 20.000 30.000 40.000 50.000 60.000 70.000 80.000 90.000 100.000 GDP per capita, PPP (US $)
Pacemaker implants 1992-2016
Pacemaker type %
Pacemaker implantations (per million people) Pacemakers implantations per million people & GDP per capita, PPP(US$) 1.200 y = 374,18ln(x) - 3260,1 R² = 0,5829 ITA 1.000 FRA SWE CZE ISL DEU AUT 800 PRT LTU EST POL ESP FIN DNK BEL CHE GRC SVN GBR 600 HRV LVA HUN MLT SVK NLD NOR LUX SRB ISR BGR ESC Average IRL 400 BLR 200 TUN MNE ROU LBN RUS CYP MKD MDA TUR UKR GEO ALB KAZ KGZ ARM DZA EGY BIH 0 AZE 0 MAR 10.000 20.000 30.000 40.000 50.000 60.000 70.000 80.000 90.000 100.000 GDP per capita, PPP (US $)
ICD implants 1991-2016
ICD type %
ICD implantations (per million people) ICD implantations per million people & GDP per capita, PPP(US$) 400 y = 100,67ln(x) - 919,05 R² = 0,5096 DEU 350 CZE 300 NLD 250 POL ITA DNK 200 FRA SWE 150 ISL BEL IRL CHE NOR LUX FIN SVK ISR HUN ESP AUT 100 GRC EST GBR TUR PRT ESC Average SVN LBN MLT 50 SRB MNE CYP LTU HRV LVA GEO ROU TUN ARM MAR BLR MDA BIH BGR RUS DZA MKD KAZ 0 0 UKR 10.000 ALB 20.000 EGY AZE 30.000 40.000 50.000 60.000 70.000 80.000 90.000 100.000 XK GDP per capita, PPP (US $)
CRT-P implantations (per million people) CRT-P implantations per million people & GDP per capita, PPP(US$) 80 y = 15,286ln(x) - 131,9 R² = 0,2943 DNK 70 GBR 60 50 HUN LTU FRA SWE CZE 40 BGR BEL 30 20 10 MNE EGY TUN SRB HRV ROU SVN ITA FIN AUT NLD SVK ISL CHE ESC Average EST ISR DEU POL PRT ESP LUX LVA MLT MAR MKD GRC BIH KGZ GEO LBN UKR KAZ CYP 0 DZA 0 ALB 10.000 20.000 30.000 40.000 50.000 60.000 70.000 80.000 90.000 100.000 IRL GDP per capita, PPP (US $) NOR
CRT-D implantations (per million people) CRT-D implantations per million people & GDP per capita, PPP(US$) 180 y = 39,94ln(x) - 361,23 R² = 0,4173 ITA 160 140 CZE 120 DEU 100 ISR FRA DNK NLD 80 60 40 HUN GRC LVA POL SVK MLT PRT SVN ESP GBR FIN BEL SWE AUT IRL CHE NOR LUX LBN ESC Average 20 EST ISL MNE HRV MAR SRB LTU CYP UKR BIH TUN ROU KGZ GEO EGY RUS ALB MKD BGR KAZ 0 AZE 0 ARM 10.000 DZA 20.000 30.000 40.000 50.000 60.000 70.000 80.000 90.000 100.000 GDP per capita, PPP (US $)
ICD and PPM/million 7500-9000 PPMs 900-1150 ICDs
Θεσσαλονίκη-Βηματοδότες
Θεσσαλονίκη-Απινιδωτές
Ablation: Current Situation in Greece 30 Ablation centers/teams (27 hospitals) 8 University 6 NHS 2 Military 1 Semi-Private 10 Private
Ablations (per million people) Ablations per million people & GDP per capita, PPP(US$) 900 y = 219,11ln(x) - 1980,1 R² = 0,5313 800 DEU 700 DNK 600 CHE CZE BEL 500 FRA NOR 400 FIN SWE NLD HUN AUT LVA EST 300 LTU ESP LUX GBR POL ISR ISL HRV ESC Average SVN IRL 200 SVK TUR PRT RUS SRB GRC MNE CYP 100 TUN BLR GEO KAZ BGR ROU ARM UKR MKD LBN KGZ ALB EGY AZE DZA MLT 0 MAR 0 10.000 20.000 30.000 40.000 50.000 60.000 70.000 80.000 90.000 100.000 GDP per capita, PPP (US $)
Demographics 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Number of patients 874 1244 1226 1279 1369 1348 1484 1829 2187 2371 Number of procedures 904 1317 1320 1316 1410 1379 1535 1882 2244 2479 Age (years) 51.3 50.1 49.8 51.2 50.5 51.9 54.1 53.2 54.2 54.8 Gender 53.8/4 56.3/4 58.7/4 60.9/3 62.2/3 58.3/4 61.5/38. 61.6/38. 64.6/35. 65/35 (male/femal 6.2 3.7 1.3 9.1 7.8 1.7 5 4 4 e) %
%AF ablation@volume 655 811 825 19 centers 7 centers>100 20 centers 6 centers>100 21 centers 7 centers>100
CHB and PPM implantation
Συμπεράσματα Ολες οι πράξεις εκτελούνται με επιτυχία στην Ελλάδα H κατάλυση της ΚΜ είναι η συχνότερη επέμβαση Οι περισσότερες επεμβάσεις γίνονται σε μικρό αριθμό κέντρων Αποτελέσματα άμεσα συγκρίσιμα με αυτά μεγάλων κέντρων του εξωτερικού Σημαντική η συμμετοχή στις Εθνικές καταγραφές
AF ablation 2015-2017 2015 19 centers n=655 out of total=1739 7 centers >100 cases/year, n=562 out of total=1354 9 centers >50 cases/year, n=579 out of total=1463 2016 20 centers n=811 out of total=2173 6 centers >100 cases/year, n=610 out of total=1451 13 centers >50 cases/year, n=733 out of total=1955 2017 21 centers n=825 out of total=2401 7 centers >100 cases/year, n=625 out of total=1677 16 centers >50 cases/year, n=795 out of total=2262
AF ablation (Private vs Public) - 2015 Public 11 centers, n=303 4 centers >100 cases/year, n=264 out of total=771 5 centers >50 cases/year, n= 270 out of total=823 Private 7 centers, n=235 2 centers >100 cases/year, n=181 out of total=345 3 centers >50 cases/year, n=192 out of total=402 Private Law 1 center, n=117 1 center > 50/100 cases/year, n=117 out of total=238
AF ablation (Private vs Public) - 2016 Public 11 centers, n=372 3 centers >100 cases/year, n=291 out of total=800 7 centers >50 cases/year, n= 334 out of total=1113 Private 8 centers, n=323 2 centers >100 cases/year, n=203 out of total=395 5 centers >50 cases/year, n=283 out of total=586 Private Law 1 center, n=116 1 center > 50/100 cases/year, n=116 out of total=256
AF ablation (Private vs Public) - 2017 Public 11 centers, n=410 4 centers >100 cases/year, n=361 out of total=1048 7 centers >50 cases/year, n= 381 out of total=1259 Private 9 centers, n=324 2 centers >100 cases/year, n=173 out of total=381 8 centers >50 cases/year, n= 323 out of total=755 Private Law 1 center, n=91 1 center > 50/100 cases/year, n=91 out of total=248