The association of multimorbidity to mortality in older adults after permanent pacemaker placement

• Published in: Pacing and clinical electrophysiology 2021-05, Vol.44 (5), p.919-928
• Main Authors: Krishnaswami, Ashok, Liu, Taylor I., Harris, Jessica, Prentice, Heather A., Paxton, Elizabeth W., Masoudi, Frederick A.
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aged, 80 and over; Body Mass Index; Bradycardia; Bradycardia - mortality; Bradycardia - therapy; Comorbidity; Decision making; Elixhauser; Female; geriatrics; Humans; Male; Mortality; Multimorbidity; multiple chronic conditions; older adults; Pacemaker, Artificial; Pacemakers; permanent pacemaker; Prediction models; Prognosis; Risk Factors; Survival; Survival Analysis; United States
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/pace.14238

Background In the United States 2018 bradycardia guideline, the current class III recommendation that patients with permanent pacemaker (PPM) indications and high multimorbidity burden may not have meaningful clinical benefit from PPM therapy is based on limited data. Methods Observational study (January 1, 2008–December 31, 2015) of adults ≥65 years (N = 16,678) who underwent PPM implantation. Exposure variable: Elixhauser comorbidity number (ECN, 29 well‐validated conditions). Primary outcome: ≤1‐year mortality; secondary outcome: > 1‐year mortality. Results Those who died ≤1‐year were older, had a lower body mass index (BMI), and higher ECN (p 1‐year (HR 1.19 [95% CI: 1.17–1.20]) mortality. A predictive model including age, sex, BMI, PPM type, race, and ECN had greater discriminative ability (p 1‐year) should be routinely discussed during the shared decision‐making process as an important prognostic geriatric domain variable.