Appendix C Detail on criteria for audit of the use of dual‑chamber pacemakers for symptomatic bradycardia due to sick sinus syndrome and/or atrioventricular block

Appendix C Detail on criteria for audit of the use of dual‑chamber pacemakers for symptomatic bradycardia due to sick sinus syndrome and/or atrioventricular block

Possible objectives for an audit

An audit could be carried out to ensure that dual‑chamber pacing is used appropriately for the management of symptomatic bradycardia due to sick sinus syndrome and/or atrioventricular block.

Possible patients to be included in the audit

An audit could be carried out on people with symptomatic bradycardia associated with sick sinus syndrome, atrioventricular block, or a combination of sick sinus syndrome and atrioventricular block who are seen in a reasonable period for audit, for example 3 or 6 months. People with more complex pacing indications should be excluded from this audit.

Measures that could be used as a basis for an audit

The measure that could be used in an audit of the management of symptomatic bradycardia to ensure that dual‑chamber pacing is used appropriately as follows.

Criterion

Standard

Exception

Definition of terms

1. Dual‑chamber pacing is used for the management of symptomatic bradycardia associated with any of the following:

a. sick sinus syndrome (SSS)

b. atrioventricular block (AVB)

c. a combination of SSS and AVB

100% of people with symptomatic bradycardia associated with SSS, AVB or a combination of SSS and AVB

A. The patient has SSS with no evidence of impaired atrioventricular conduction and single‑chamber atrial pacing is used or

B. The patient has AVB with continuous atrial fibrillation and the risk of inappropriate atrial capture is high and single‑chamber ventricular pacing is used

C. The patient has AVB (alone or in combination with SSS) and single‑chamber ventricular pacing is preferred by the clinician on the basis of consideration of the risks and benefits for the patient‑specific factors

Sick sinus syndrome is also known as sinus node dysfunction.

See Appendix D for pacemaker nomenclature.

Patients who meet exception A must have had a full evaluation, which clinicians will need to define locally for audit purposes.

Clinicians will need to agree locally on how consideration of dual‑ or single‑chamber pacing is documented for audit purposes, for example, for exception C with reference to patient factors such as frailty or the presence of comorbidities that may influence the balance of risks and benefits.

Calculation of compliance

Compliance (%) with each measure described in the table above is calculated as follows.

Number of patients whose care is consistent with the criterion plus number of patients who meet any exception listed

x 100

Number of patients to whom the measure applies

Clinicians should review preliminary compliance with each measure and the patients whose care was not consistent with the audit measure. Clinicians may use their clinical judgement and conclude that some patients whose care is not consistent with the audit measure nevertheless were provided with the most appropriate care for their conditions. Clinicians should then decide whether practice can be improved, agree on a plan to achieve any desired improvement and repeat the measurement of actual practice to confirm that the desired improvement is being achieved.