---
title: "Access to CIED Therapy in the ESC EuroAsia Region: Comparative Analysis of Implantation, Infrastru"
id: "pubmed-42247583"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42247583"
content_type: "clinical_feed_article"
specialty: "Cardiology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42247583/"
doi: "10.1093/ehjqcco/qcag099"
published_at: "2026-09-16T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Access to CIED Therapy in the ESC EuroAsia Region: Comparative Analysis of Implantation, Infrastru
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42247583
- **Specialty:** [Cardiology](https://medichelpline.com/clinical-feed/cardiology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42247583/)
- **DOI:** [10.1093/ehjqcco/qcag099](https://doi.org/10.1093%2Fehjqcco%2Fqcag099)
- **Published At:** 2026-09-16T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The study compared national-level implantation activity of **pacemakers (PMs)**, **implantable cardioverter-defibrillators (ICDs)**, and **cardiac resynchronization therapy (CRT)** devices across ESC EuroAsia Task Force countries (Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Turkmenistan, Uzbekistan). - Data were collected in 2025 via a standardized ESC EuroAsia Task Force survey and contextualized using EHRA Atlas indicators and World Bank/WHO health expenditure data. - Pacemaker implantation rates varied moderately (21–333 per million population), while ICD (0.1–172 per million) and CRT (1–135 per million) rates showed much larger disparities. - Higher density of implanting centres and greater electrophysiology workforce availability were associated with substantially higher per-capita **ICD** and **CRT** implantation rates; Georgia was highlighted as having notably greater capacity. - Exploratory analyses indicated a moderate positive correlation between national health expenditure (percentage of GDP) and ICD/CRT implantation rates. - No consistent association was observed between financing structure (out-of-pocket share versus government share) and device uptake. - The observed pattern followed a complexity gradient (PM > ICD > CRT), suggesting that access to advanced device therapy is driven more by **health system capacity** than by guideline awareness alone. - Authors recommend strengthening predictable reimbursement pathways, structured referral networks, workforce development, and national registries to reduce inequities in sudden cardiac death prevention and heart failure management. - Conflict of interest: None declared.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Melhem International Hospital, 1099 Baku, Azerbaijan. * 2 International Cardiology Centre, 744036 Ashgabat, Turkmenistan. * 3 Kyrgyz State Medical Academy, 720020 Bishkek, Kyrgyzstan. * 4 College of Medicine, Korea University, Seoul, Republic of Korea. * 5 Department of Medicine and Cardiology Unit, Karolinska Institute, Karolinska University Hospital, SE-171 76 Stockholm, Sweden. * 6 Thomas' NHS Foundation Trust, Cardiovascular Academic Group, King's College, London SE5 9RS, UK. * 7 National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK. * 8 Department of Cardiology, National Medical Institute of the Ministry of Interior and Administration, 02-507 Warsaw, Poland. * 9 Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland. * PMID: **42247583** * DOI: [ 10.1093/ehjqcco/qcag099 ](https://doi.org/10.1093/ehjqcco/qcag099) Item in Clipboard Comparative Study # Access to cardiac implantable electronic device therapy in the European Society of Cardiology EuroAsia region: a comparative analysis of implantation activity, infrastructure, and health financing Ulvi Mirzoyev et al. Eur Heart J Qual Care Clin Outcomes. 2026. Show details Display options Display options Format Abstract PubMed PMID Eur Heart J Qual Care Clin Outcomes Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Eur+Heart+J+Qual+Care+Clin+Outcomes%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Eur+Heart+J+Qual+Care+Clin+Outcomes%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42247583/) . 2026 Sep 16;12(6):1068-1080. doi: 10.1093/ehjqcco/qcag099. ### Authors [Ulvi Mirzoyev](https://pubmed.ncbi.nlm.nih.gov/?term=Mirzoyev+U&cauthor_id=42247583)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42247583/#short-view-affiliation-1 "Melhem International Hospital, 1099 Baku, Azerbaijan."), [Bahram Kadyrov](https://pubmed.ncbi.nlm.nih.gov/?term=Kadyrov+B&cauthor_id=42247583)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42247583/#short-view-affiliation-2 "International Cardiology Centre, 744036 Ashgabat, Turkmenistan."), [Erkin Mirrakhimov](https://pubmed.ncbi.nlm.nih.gov/?term=Mirrakhimov+E&cauthor_id=42247583)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42247583/#short-view-affiliation-3 "Kyrgyz State Medical Academy, 720020 Bishkek, Kyrgyzstan.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42247583/#short-view-affiliation-4 "College of Medicine, Korea University, Seoul, Republic of Korea."), [Cecilia Linde](https://pubmed.ncbi.nlm.nih.gov/?term=Linde+C&cauthor_id=42247583)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42247583/#short-view-affiliation-5 "Department of Medicine and Cardiology Unit, Karolinska Institute, Karolinska University Hospital, SE-171 76 Stockholm, Sweden."), [Thomas Lüscher](https://pubmed.ncbi.nlm.nih.gov/?term=L%C3%BCscher+T&cauthor_id=42247583)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42247583/#short-view-affiliation-6 "Thomas' NHS Foundation Trust, Cardiovascular Academic Group, King's College, London SE5 9RS, UK.")[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42247583/#short-view-affiliation-7 "National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK."), [Jacek Bil](https://pubmed.ncbi.nlm.nih.gov/?term=Bil+J&cauthor_id=42247583)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42247583/#short-view-affiliation-8 "Department of Cardiology, National Medical Institute of the Ministry of Interior and Administration, 02-507 Warsaw, Poland."), [Robert J Gil](https://pubmed.ncbi.nlm.nih.gov/?term=Gil+RJ&cauthor_id=42247583)[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42247583/#short-view-affiliation-9 "Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland.") ### Affiliations * 1 Melhem International Hospital, 1099 Baku, Azerbaijan. * 2 International Cardiology Centre, 744036 Ashgabat, Turkmenistan. * 3 Kyrgyz State Medical Academy, 720020 Bishkek, Kyrgyzstan. * 4 College of Medicine, Korea University, Seoul, Republic of Korea. * 5 Department of Medicine and Cardiology Unit, Karolinska Institute, Karolinska University Hospital, SE-171 76 Stockholm, Sweden. * 6 Thomas' NHS Foundation Trust, Cardiovascular Academic Group, King's College, London SE5 9RS, UK. * 7 National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK. * 8 Department of Cardiology, National Medical Institute of the Ministry of Interior and Administration, 02-507 Warsaw, Poland. * 9 Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland. * PMID: **42247583** * DOI: [ 10.1093/ehjqcco/qcag099 ](https://doi.org/10.1093/ehjqcco/qcag099) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Aims:** Access to cardiac implantable electronic device (CIED) therapy varies substantially across Europe, yet data from the European Society of Cardiology (ESC) EuroAsia region remain limited. We aimed to compare implantation activity of pacemakers (PMs), implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices across ESC EuroAsia Task Force (TF) countries and to examine how infrastructure, workforce capacity, and health financing patterns relate to device uptake. **Methods and results:** National-level aggregated data were collected in 2025 through a standardized ESC EuroAsia TF survey and contextualized using European Heart Rhythm Association Atlas indicators and World Bank/World Health Organization Health Expenditure Data. Implantation rates per million population were compared across Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Turkmenistan, and Uzbekistan. Pacemaker implantation showed moderate variability (21-333 per million), whereas ICD (0.1-172 per million) and particularly CRT (1-135 per million) implantation demonstrated pronounced disparities. Countries with higher density of implanting centres and greater electrophysiology workforce availability-most notably Georgia-had substantially higher per capita ICD and CRT implantation rates. Exploratory analyses suggested moderate positive correlations between national health expenditure (%gross domestic product) and ICD and CRT implantation rates, whereas financing structure (out-of-pocket vs. government share) showed no consistent association. **Conclusion:** Cardiac implantable electronic device implantation activity in the ESC EuroAsia region follows a clear complexity gradient (PM > ICD > CRT), indicating that access to advanced device therapy is primarily determined by system capacity rather than guideline awareness alone. Strengthening predictable reimbursement pathways, structured referral networks, workforce development, and national registries may reduce inequities and narrow the evidence-practice gap in sudden cardiac death prevention and heart failure management. **Keywords:** Cardiac implantable electronic devices; Cardiac resynchronization therapy; Health financing; Health system capacity; Implantable cardioverter-defibrillator; Inequalities in cardiovascular care. © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Conflict of interest: None declared. ## Similar articles * [ A Decade of Information on the Use of Cardiac Implantable Electronic Devices and Interventional Electrophysiological Procedures in the European Society of Cardiology Countries: 2017 Report from the European Heart Rhythm Association. ](https://pubmed.ncbi.nlm.nih.gov/28903470/) Raatikainen MJP, Arnar DO, Merkely B, Nielsen JC, Hindricks G, Heidbuchel H, Camm J.Raatikainen MJP, et al.Europace. 2017 Aug 1;19(suppl_2):ii1-ii90. doi: 10.1093/europace/eux258.Europace. 2017.PMID: 28903470 * [ Why atrial fibrillation ablation remains underused in EuroAsia Task Force countries: insights from the ESC-EHRA Atlas and a regional survey. ](https://pubmed.ncbi.nlm.nih.gov/42721058/) Abdrakhmanov A, Zhumagali Z, Linde C, Suleymen Z, Berkinbayev S, Abdrakhmanova Z, Yerikkyzy M, Chinybayeva A, Yessimbekova E, Bil J, Gil RJ.Abdrakhmanov A, et al.Cardiol J. 2026;33:e00226069. doi: 10.5603/cj.112081.Cardiol J. 2026.PMID: 42721058Free PMC article. * [ Current trends in the use of cardiac implantable electronic devices and interventional electrophysiological procedures in the European Society of Cardiology member countries: 2015 report from the European Heart Rhythm Association. ](https://pubmed.ncbi.nlm.nih.gov/26286028/) Raatikainen MJ, Arnar DO, Zeppenfeld K, Merino JL, Kuck KH, Hindricks G.Raatikainen MJ, et al.Europace. 2015 Aug;17 Suppl 4:iv1-72. doi: 10.1093/europace/euv265.Europace. 2015.PMID: 26286028 * [ Economic Considerations of Cardiovascular Implantable Electronic Devices for The Treatment of Heart Failure. ](https://pubmed.ncbi.nlm.nih.gov/38662154/) Elsner C, Bettin S, Tilz R, Häckl D.Elsner C, et al.Curr Heart Fail Rep. 2024 Jun;21(3):186-193. doi: 10.1007/s11897-024-00664-y. Epub 2024 Apr 25.Curr Heart Fail Rep. 2024.PMID: 38662154Review. * [ Remote Monitoring of Implantable Cardioverter-Defibrillators, Cardiac Resynchronization Therapy and Permanent Pacemakers: A Health Technology Assessment. ](https://pubmed.ncbi.nlm.nih.gov/30443279/) Health Quality Ontario.Health Quality Ontario.Ont Health Technol Assess Ser. 2018 Oct 24;18(7):1-199. eCollection 2018.Ont Health Technol Assess Ser. 2018.PMID: 30443279Free PMC article.Review. [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42247583) ## Publication types * Comparative Study Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Comparative+Study%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Comparative+Study) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42247583/) ## MeSH terms * Cardiac Resynchronization Therapy* / economics Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Cardiac+Resynchronization+Therapy%2Feconomics%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Cardiac+Resynchronization+Therapy) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42247583/) * Cardiac Res
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