Abstract 15827: Views of Patients and Family Members in Nicaragua and Pakistan Regarding Pacemaker Reutilization
Introduction: Many patients in developing nations have neither the financial resources nor insurance to pay for a pacemaker for the treatment of symptomatic bradycardia. Reprocessed, resterilized pacemakers may improve access to this therapy. No data exist on potential recipients’ acceptance of re-used pacemakers and associated risks.
Methods: 593 patients or family members at the cardiology clinic at Centro Nacional Cardiologia in Managua, Nicaragua (100 respondents) and Indus General Hospital in Karachi, Pakistan (493 respondents) were surveyed regarding device reutilization.
Results: The mean age of respondents was 43 (standard deviation 14 years); 61% of respondents were female. 96% were not able to afford the cost of a used pacemaker (150,000 Pakistani Rupees or 18,000 Cordobas). 77% of respondents would accept a reprocessed device if the risks were similar to a new device, 68% would accept a reprocessed device if the risk of device failure were higher than a new device, and 56% would accept a reprocessed device if the risk of infection were higher than a new device. There were no significant differences in the willingness to accept a used device (with or without higher risks) between countries. Although the majority of respondents were willing to accept a reprocessed device across all categories, the ability to pay for a new pacemaker (52% v. 79%, p=0.01), excellent health status (65.5% v. 77.7% p=0.046) and lack of experience with heart disease in oneself or a family member (67.4% v. 77.9% p=0.03) were negatively associated with willingness to accept a used device.
Conclusions: Large majorities of patients and families surveyed at outpatient clinics in Nicaragua and Pakistan cannot afford the cost of a new pacemaker. Respondents are willing to accept a recycled pacemaker despite a higher risk of infection or device failure. The results of this survey suggest that re-use of pacemakers may be a reasonable option for delivery of bradyarrhythmia therapy in those countries.
- © 2013 by American Heart Association, Inc.