ICD Use Data: Global and Bangladesh Scenario

Note on Terminology: "ICD" in this context refers to the Implantable Cardioverter-Defibrillator (cardiac device). The final WHO search also returned results for the WHO ICD-11 (disease classification system) - both are addressed below where relevant.

PART A: Global ICD (Cardiac Device) Scenario

1. Burden Driving ICD Need (WHO Data)

• 19.8 million people died from cardiovascular diseases (CVDs) globally in 2022 - approximately 32% of all global deaths
• 85% of CVD deaths were due to heart attack and stroke
• Over 75% of CVD deaths occur in low- and middle-income countries (LMICs)
• Approximately 25% of all CVD deaths are attributable to Sudden Cardiac Death (SCD) - the primary target for ICD therapy
• The US NIH estimated ~450,000 sudden cardiac deaths annually in the United States alone

2. Global ICD Market and Implantation Volume

• Europe dominates the ICD market with 50.52% share (2025), driven by high adoption, favorable reimbursement, and awareness
• North America dominates the broader defibrillator market with 44% share (2024), led by the US with Medicare/Medicaid reimbursement
• Subcutaneous ICD (S-ICD) is the fastest-growing segment, projected to reach USD 2,867 million by 2035 from USD 1,288 million in 2024

3. Stark Disparity: High vs. Low-Income Countries

4. Clinical Efficacy (Basis for Global Guidelines)

• ICD reduces all-cause mortality by 31% in post-MI patients with LVEF ≤30% (MADIT-II trial)
• ~75% of primary prevention ICD recipients never require appropriate therapy during their first device's life
• ~25% of primary prevention patients improve LVEF to >35% after implant
• Complication rates: overall adverse events ~9.1%; lead-related ~5.8%; infection 0.2-3.7%; inappropriate shock 3-21%

PART B: Bangladesh ICD Scenario (DGHS / MOHFW Data)

1. National Cardiovascular Disease Context

• CVDs are the leading cause of NCD-related mortality in Bangladesh
• DGHS operates the Multisectoral Action Plan for Prevention and Control of NCDs 2018-2025 under MOHFW
• The DGHS DHIS-2 (District Health Information System) collects routine health facility data nationally, but granular ICD-specific implant numbers are not publicly reported in open-access DGHS Health Bulletins

2. ICD Availability and Access in Bangladesh

• ICD implantation is available in Bangladesh at select tertiary centers, but access is severely limited
• No exemption from costs is typically available, though the Social Welfare Department can recommend free or partial payment for low-income individuals
• The DGHS NCD program covers hypertension, diabetes, COPD, and cancer screening at primary care level - advanced cardiac devices like ICDs are not part of the primary health package

3. Key Structural Barriers in Bangladesh

1. Affordability: ICD devices cost USD 700-1,400+ (BDT 75,000-150,000 listed above is likely underestimated for imported devices); most patients pay out-of-pocket
2. Specialist shortage: Very few electrophysiologists trained in ICD implantation; concentrated in Dhaka (BSMMU, NICVD, private hospitals)
3. No national registry: DGHS does not publish annual ICD implant volume data publicly; this is a major data gap
4. NHSTP coverage gap: ICD is not included in Bangladesh's national health service package for subsidized care
5. Follow-up infrastructure: Remote monitoring and device follow-up capacity is extremely limited outside major urban centers

4. DGHS NCD Program Framework (Relevant to ICD Policy)

PART C: WHO ICD-11 (Disease Classification) - Bangladesh Context

• As of May 2024, 132 WHO member states are at various phases of ICD-11 implementation
• 14 countries have begun collecting or reporting data using ICD-11 coding
• 50 countries are conducting or expanding pilots
• Bangladesh, through DGHS DHIS-2, currently uses earlier coding systems; ICD-11 transition is ongoing but not yet complete, which limits standardized reporting of cardiac device use data nationally

Summary and Key Gaps

Recommendation for researchers/policy: For Bangladesh-specific ICD volume data, direct requests to DGHS MIS (Management Information System), NICVD (National Institute of Cardiovascular Diseases, Dhaka), or BSMMU cardiology department would be the most reliable channels, as this data is not currently in open-access national health bulletins.

International Classification of Diseases (ICD): Global & Bangladesh Scenario

PART 1: What is the ICD?

• Mortality statistics (cause-of-death certification)
• Morbidity recording (clinical diagnoses at all care levels)
• Health resource planning and financing (DRG/casemix systems)
• Epidemiological surveillance and research
• Billing and reimbursement (in systems with activity-based funding)

PART 2: ICD Timeline and Versions

PART 3: Global ICD Scenario (WHO Data)

3.1 ICD-10 Global Use (Legacy)

• Adopted by at least 120 countries worldwide for both mortality and morbidity reporting
• Remains the active system in most LMICs and in the United States (for clinical billing, ICD-10-CM)
• Alphanumeric codes: A00.0 to Z99.9
• The US introduced its own clinical modification: ICD-10-CM (still in use for billing as of 2025-2026)

3.2 ICD-11 Global Adoption Progress (WHO Official Data)

3.3 ICD-11: What's New? (Key Features vs ICD-10)

3.4 Countries Leading ICD-11 Adoption (2025)

• Fully active users: Canada, Netherlands, Norway, Finland, Thailand
• Advanced pilots: Germany, Australia, Malaysia, Saudi Arabia
• Exploratory phase: United States (NCHS and CMS conducting research; ICD-11 not yet mandated for billing; potential shift by 2027)

3.5 Annual ICD-11 Updates

PART 4: Bangladesh ICD Scenario (DGHS Context)

4.1 Current Status

• Bangladesh was listed as a participant in ICD-11 consultations as far back as the 2018 WHO ICD-11 launch planning (NAHDO document lists Bangladesh among contributing countries)
• No confirmed full ICD-11 rollout in Bangladesh as of 2025-2026 - it remains in the pre-adoption or awareness phase

4.2 DGHS Health Data Infrastructure

4.3 ICD Use in Bangladesh: Key Gaps and Challenges

4.4 WHO SEARO Support for Bangladesh

• Strengthening CRVS (Civil Registration and Vital Statistics) - foundational to ICD-based mortality data
• Training for verbal autopsy methods (used when physician-certified cause of death is unavailable)
• NCD surveillance using ICD codes under the STEPS survey framework
• Alignment with the WHO PEN (Package of Essential NCD interventions) protocol, which uses ICD-coded disease categories

4.5 DGHS Health Bulletin Data (ICD-coded disease categories)

PART 5: Summary Comparison Table

Key Takeaway

Bangladesh's First Official Use of ICD-10

The Key Finding

Background: Why It Took Until 2011

"We, at the Management Information System (MIS) of the DGHS, were facing enormous problem in processing disease and cause-specific data due to absence of practice of ICD-10 in our health facilities. We were in urgent need for introducing use of ICD-10 in medical practice of Bangladesh."

• Prof. Dr. Abul Kalam Azad, Additional Director General & Director MIS-Health, DGHS (2011)

The 2011 First Edition: Key Facts

Subsequent Editions (DGHS ICD-10 Publication Timeline)

What the First Edition Directed

1. All government and private health and medical institutions must essentially use ICD-10 in preparing records and reports
2. 3rd and 4th year medical and dental students to receive orientation in ICD-10 code writing during clinical history taking
3. MIS-Health to develop online/offline software for ICD-10 coding and provide it to medical institutions
4. Computerized self-learning modules to be circulated via the DGHS website
5. Regular training by MIS-DGHS with WHO Bangladesh support

Summary

Source: DGHS Guidebook on ICD-10, 1st Edition, November 2011 - MIS-Health, DGHS, MOHFW, Government of Bangladesh

References

1. Official Government / DGHS Documents

1. Management Information System (MIS-Health), Directorate General of Health Services (DGHS), Ministry of Health & Family Welfare, Government of Bangladesh. Guidebook on ICD-10, 1st Edition. November 2011. Dhaka: DGHS. Available at: https://objectstorage.ap-dcc-gazipur-1.oraclecloud15.com/n/axvjbnqprylg/b/V2Ministry/o/office-dghs/2024/12/a5d69d38963d476f8e13e85c54c22ef6.pdf
2. MIS-Health, DGHS, MOHFW. Guidebook on ICD-10, 2nd Edition. July 2013. Dhaka: DGHS. Available at: http://old.dghs.gov.bd/index.php/en/icd-10/item/guidebook-on-icd-10-second-edition-july-2013
3. MIS-Health, DGHS, MOHFW. Guidebook on ICD-10, 3rd Edition. January 2015. Dhaka: DGHS. Available at: http://old.dghs.gov.bd/index.php/en/icd-10/item/icd-10-guidebookthird-edition2015
4. MIS-Health, DGHS, MOHFW. Health Bulletin 2023. Dhaka: DGHS. Available at: https://objectstorage.ap-dcc-gazipur-1.oraclecloud15.com/n/axvjbnqprylg/b/V2Ministry/o/office-dghs/2024/12/186aa25dee52477a817cb494853355d4.pdf
5. DGHS. ICD-10 Archive Page (Training Manual, Guidebooks, Bangla Classification). Available at: http://old.dghs.gov.bd/index.php/en/icd-10
6. DGHS. DHIS-2: District Health Information System - Interface for Collection of Nation-wide Health Data. Available at: https://old.dghs.gov.bd/index.php/en/e-health/our-ehealth-eservices/84-english-root/ehealth-eservice/94-dhis-interface-for-collection-of-nation-wide-health-data
7. MOHFW & DGHS, Government of Bangladesh. Multisectoral Action Plan for Prevention and Control of Noncommunicable Diseases 2018-2025 with Three-Year Operational Plan. May 2018. Dhaka: MOHFW.

2. World Health Organization (WHO)

1. World Health Organization. International Classification of Diseases (ICD) - Main Page. Geneva: WHO. Available at: https://www.who.int/standards/classifications/classification-of-diseases
2. World Health Organization. ICD-11 Implementation - Frequently Asked Questions. Last updated December 2, 2025. Geneva: WHO. Available at: https://www.who.int/standards/classifications/frequently-asked-questions/icd-11-implementation
3. World Health Organization. WHO Releases 2025 Update to the International Classification of Diseases (ICD-11). February 14, 2025. Geneva: WHO. Available at: https://www.who.int/news/item/14-02-2025-who-releases-2025-update-to-the-international-classification-of-diseases-(icd-11)
4. World Health Organization. Cardiovascular Diseases (CVDs) - Fact Sheet. 2024. Geneva: WHO. Available at: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
5. World Health Organization. ICD-11 2026 Release. February 16, 2026. Geneva: WHO. Available at: https://www.who.int/standards/classifications/classification-of-diseases

3. International / Intergovernmental Reports

1. European Union Agency for Asylum (EUAA). Medical Country of Origin Information: Bangladesh - Cardiology. Finalized December 18, 2023; published February 2024. Available at: https://www.euaa.europa.eu/sites/default/files/publications/2024-02/2024_02_MedCOI_Report_Bangladesh_Cardiology.pdf
2. European Society of Cardiology (ESC). Cardiovascular Disease Disproportionately Affects Middle-Income Countries [Press Release based on ESC Atlas of Cardiology]. August 27, 2024. Sophia Antipolis: ESC. Available at: https://www.escardio.org/news/press/press-releases/Cardiovascular-disease-disproportionately-affects-middle-income-countries
3. World Heart Federation. World Heart Report 2024. Geneva: WHF. Available at: https://world-heart-federation.org/report2024

4. Peer-Reviewed / Academic Sources

1. Roth GA, et al. The Heart of the World. Global Heart. 2024;19(1):11. PMC10809869. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10809869
2. Khera S, et al. Incidence and Predictors of Implantable Cardioverter-Defibrillator Therapies After Generator Replacement - A Pooled Analysis of 31,640 Patients' Data. Innovations in CRM. December 2022. Available at: https://www.innovationsincrm.com/cardiac-rhythm-management/articles-2022/december/2005-incidence-and-predictors-of-implantable-cardioverter-defibrillator-therapies
3. Beatty AL, et al. "Real Life" Longevity of Implantable Cardioverter-Defibrillator Devices. Journal of the American Heart Association. 2019. PMC6490531. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC6490531
4. Kostanjsek N, et al. ICD-11: An International Classification of Diseases for the Twenty-First Century. BMC Medical Informatics and Decision Making. 2021;21(Suppl 6):206. PMC8577172. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC8577172
5. Ahmad Fuad AS, et al. Facilitators and Challenges to ICD-11 Implementation: A Qualitative Study Using the Consolidated Framework for Implementation Science. Health Information Management Journal. 2025. PMC12372348. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12372348

5. Market / Industry Reports

1. Fortune Business Insights. Implantable Cardioverter Defibrillator Market Size, Share & Forecast Report, 2034. 2025. Available at: https://www.fortunebusinessinsights.com/industry-reports/implantable-cardioverter-defibrillator-market-100474
2. Market Data Forecast. Defibrillator Market Size, Share & Analysis, 2033. 2024. Available at: https://www.marketdataforecast.com/market-reports/defibrillators-market
3. Future Market Insights. Subcutaneous Implantable Defibrillator Market Size 2025-2035. April 2025. Available at: https://www.futuremarketinsights.com/reports/subcutaneous-implantable-defibrillator-market

6. News / Professional / Other

1. ICD10 Monitor / MedLearn. ICD-11 in 2025: Evolution, Global Progress, and What to Watch. 2025. Available at: https://icd10monitor.medlearn.com/icd-11-in-2025-evolution-global-progress-and-what-to-watch
2. Sprypt. ICD-11 Implementation Delayed to 2027? What Coders Must Know. 2025. Available at: https://www.sprypt.com/blog/icd-10-vs-icd-11
3. Medscape / eMedicine. Cardioverter-Defibrillator Implantation: Practice Essentials, Background, Indications. Available at: https://emedicine.medscape.com/article/1839525-overview

Note on primary source: The most authoritative reference for Bangladesh's first official ICD-10 use is Reference 1 - the DGHS Guidebook on ICD-10, 1st Edition (November 2011) - which is a primary government document published by MIS-DGHS with WHO Bangladesh support, and explicitly states it was the inaugural national effort to introduce ICD-10 into Bangladesh's health facilities.

References (Harvard Style)

Official Government / DGHS Documents

World Health Organization (WHO)

International / Intergovernmental Reports

Peer-Reviewed / Academic Sources

Market / Industry Reports

News / Professional Sources