Procedural and cardiovascular outcomes of geriatric vs non-geriatric patients undergoing permanent pacemaker implantation - a nationwide cohort analysis

Ayesha Shaik; Madhuwani Rojulpote; Nicholas Roma; Neel Patel; Yasar Sattar; Harshith Thyagaturu; Muchi Ditah Chobufo; Raahat Bansal; Anas Alharbi; Amro Taha; Sameer Raina; Karthik Gonuguntla

doi:10.62347/FIRV6475

Procedural and cardiovascular outcomes of geriatric vs non-geriatric patients undergoing permanent pacemaker implantation - a nationwide cohort analysis

Am J Cardiovasc Dis. 2024 Apr 15;14(2):128-135. doi: 10.62347/FIRV6475. eCollection 2024.

Authors

Affiliations

¹ Department of Cardiovascular Medicine, Hartford Hospital Hartford, CT, USA.
² Department of Internal Medicine, Rush University Chicago, IL, USA.
³ Department of Internal Medicine, St. Luke's University Health Network Bethlehem, PA, USA.
⁴ Department of Internal Medicine, New York Medical College/Landmark Medical Center Woonsocket, RI, USA.
⁵ Department of Cardiovascular Medicine, Heart and Vascular Institute, West Virginia University Morgantown, WV, USA.
⁶ Department of Medicine, Weiss Memorial Hospital Chicago, IL, USA.
⁷ Department of Cardiovascular Medicine, Stanford College of Medicine Stanford, CA, USA.

Abstract

Background: Permanent pacemaker implantation is increasing exponentially to treat atrio-ventricular block and symptomatic bradyarrhythmia. Despite being a minor surgery, immediate complications such as pocket infection, pocket hematoma, pneumothorax, hemopericardium, and lead displacement do occur.

Methods: The Nationwide Inpatient Sample was queried from 2016 to 2018 to identify patients with pacemakers using ICD-10 procedure code. The Chi-square test was used for statistical analysis.

Results: The sample size consisted of 443,460 patients with a pacemaker, 26% were <70 years (male 57%, mean age of (60.6±9.7) yr, Caucasian 70%) and 74% were ≥70 years (male 50%, mean age of (81.4±5.9) yr, Caucasian 79%). Upon comparison of rates in the young vs elderly: mortality (1.6% vs 1.5%; P<0.01), obesity (26% vs 13%; P<0.001), coronary artery disease (40% vs 49%; P<0.001), HTN (74% vs 87%; P<0.01), anemia (4% vs 5%; P<0.01), atrial fibrillation (34% vs 49%; P<0.01), peripheral artery disease (1.7% vs 3%; P<0.01), CHF (31% vs 39%; P<0.001), diabetes (31% vs 27.4%; P<0.01), vascular complications (1.1% vs 1.2%; P<0.01), pocket hematoma (0.5% vs 0.8%; P<0.01), AKI (16% vs 21%; P<0.01), hemopericardium (0.1% vs 0.1%; P = 0.1), hemothorax (0.3% vs 0.2%; P<0.01), cardiac tamponade (0.4% vs 0.5%; P<0.01), pericardiocentesis (0.4% vs 0.4%; P<0.01), cardiogenic shock (4% vs 2.3%; P<0.01), respiratory complications (1.9% vs 0.9%; P<0.01), mechanical ventilation (5.1% vs 2.9%; P<0.01); post-op bleed (0.5% vs 0.3%; P<0.01), need for transfusion (4.8% vs 3.8%; P<0.01), severe sepsis (0.6% vs 0.5%; P<0.01 ), septic shock (2% vs 1%; P<0.01), bacteraemia (0.8% vs 0.4%; P<0.01), lead dislodgement (1.4% vs 1.1%; P<0.01).

Conclusions: Our study revealed that the overall complication rates were lower in the elderly despite higher co-morbidities. This aligns with previous studies which showed lower rates in the elderly. Hence providers should not hesitate to provide guideline driven pacemaker placement in the elderly especially in patients with good life expectancy.

Keywords: NIS; Pacemaker; elderly; pacemaker complications; sinus node dysfunction.