What is the clinical evidence from this study?

Study design: Observational. Population: Cardiac implantable electronic device (CIED) therapy. Intervention: Infrastructure, workforce capacity, and health financing. Primary outcome: Implantation rates per million population.

What does this research mean for the field?

Access to advanced cardiac implantable electronic device therapy in the ESC EuroAsia region exhibits pronounced disparities and is primarily driven by healthcare system capacity and infrastructure rather than guideline awareness. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study compares the implantation activity of cardiac devices across ESC EuroAsia countries and explores factors influencing access.

June 7, 2026

Access to cardiac implantable electronic device therapy in the ESC EuroAsia region: a comparative analysis of implantation activity, infrastructure, and health financing

Key Result

CIED implantation rates varied widely across 7 ESC EuroAsia countries (pacemakers 21-333, ICDs 0.1-172, CRTs 1-135 per million), driven primarily by system capacity and workforce availability.

Key Points

This study compares the implantation activity of cardiac devices across ESC EuroAsia countries and explores factors influencing access.
Collected national-level data through a standardized ESC EuroAsia TF survey, including indicators from the EHRA Atlas.
Analyzed implantation rates per million population across Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Turkmenistan, and Uzbekistan in 2025.
Contextualized data with World Bank/WHO health expenditure data.
Pacemaker implantation rates ranged from 21 to 333 per million; ICD rates varied from 0.1 to 172 per million, and CRT from 1 to 135 per million.
Georgia exhibited significantly higher per-capita ICD and CRT rates due to greater density of implanting centers and workforce availability.
Moderate positive correlations were observed between national health expenditure (%GDP) and ICD and CRT implantation rates.

Study Design

Type

Observational

Multicenter

Yes

Structured PICO

Population

National-level aggregated data from 7 ESC EuroAsia countries comparing implantation rates of pacemakers, ICDs, and CRT devices.

Exposure

Cardiac implantable electronic device (CIED) therapy (pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy)

Outcome

Implantation rates per million population

Access to advanced CIED therapy in the ESC EuroAsia region is highly variable and primarily determined by system capacity and workforce availability rather than guideline awareness alone.

Abstract

Abstract Aims Access to cardiac implantable electronic device (CIED) therapy varies substantially across Europe, yet data from the ESC EuroAsia region remain limited. We aimed to compare implantation activity of pacemakers (PM), implantable cardioverter-defibrillators (ICD), 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 National-level aggregated data were collected in 2025 through a standardized ESC EuroAsia TF survey and contextualized using EHRA Atlas indicators and World Bank/WHO health expenditure data. Implantation rates per million population were compared across Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Turkmenistan, and Uzbekistan. Results 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 centers 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 (%GDP) and ICD and CRT implantation rates, whereas financing structure (out-of-pocket vs. government share) showed no consistent association. Conclusion CIED 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.

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