Predictors of long-term survival prior to permanent pacemaker implantation in octogenarians or older

Abstract

Background There is an increased need for permanent pacemaker (PPM) implantation for older patients with multiple comorbidities. The current guidelines recommend that, before implanting PPM, clinicians should discuss life expectancy with patients and their families as part of the decision-making process. However, estimating individual life expectancy is always a challenge. Aims We investigated predictors of long-term survival prior to PPM implantation in patients aged 80 or older. Methods and results From September 2004 to September 2015, 100 patients aged ≥ 80 years who received PPM implantation were included for retrospective survival analysis. The end point was all-cause mortality. Follow-up duration was 4.0 ± 2.7 years. By the end of the study, 54 patients (54%) had died. Of the 54 who died, 40 patients (74.1%) died of non-cardiac causes. Their survival rates at 1, 2, 3, 5, and 7 years were 90%, 76%, 54%, 32%, and 16%, respectively. Patients with a longer length of hospital stay before PPM implantation (LOS-B) [hazard ratio (HR) 1.03, 95% confidence interval (CI) 1.02–1.05, p < 0.001], estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73 m 2 (HR 4.07, 95% CI 1.95–8.52, p < 0.001), body mass index (BMI) < 21 kg/m 2 (HR 2.50, 95% CI 1.16–5.39, p = 0.02), and dyspnea as the major presenting symptom (HR 2.88, 95% CI 1.27–6.55, p = 0.01) were associated with lower cumulative survival. Conclusions Longer LOS-B, lower eGFR and BMI, and dyspnea as the major presenting symptom are pre-PPM implantation predictors of long-term survival in patients aged 80 or older.

Predictors of outcomes in hospitalized patients undergoing pacemaker insertion: Analysis from the national inpatient database (2016‐2017)

“…To our knowledge, this is the first study to identify an association between chronic liver disease and mortality after pacemaker implantation. Previously published data studying mortality predictors post‐pacemaker implantation did not include patients with liver cirrhosis 8,9 . The exact cause of increased mortality in this population is unclear.…”

“…Protein‐calorie malnutrition has been previously identified as a poor prognostic factor in the setting of heart failure, angina pectoris, peripheral artery disease, and most recently pacemaker implantation 8,9 . In 2018, predictors of long‐term survival post‐pacemaker implantation in patients older than 80 years were evaluated and BMI <21 kg/m 2 was associated with significantly decreased long‐term survival post‐pacemaker implantation, while BMI >27 kg/m 2 was not associated with decreased rates of survival 8 . This was confirmed in a 2019 study evaluating the correlation between pre‐operative nutritional status and mortality in 521 patients, with a mean age of 79 years, who underwent pacemaker implantation 9 .…”

The effect of body mass index on complications in cardiac implantable electronic device surgery

“…13 Here, patients with a BMI > 27 kg/m 2 were associated with longer survival than those with a BMI < 21 kg/m 2 . 13 In the elderly patient group, factors such as malnutrition, sarcopenia and frailty may have been effective in mortality. In the study by Polat et al, ventricular tachycardia and allcause mortality were more common in the non-obese patient group.…”

“…In a study by De Sensi et al., high BMI was associated with unsuccessful puncture attempt or cannulation failure, and revealed the importance of ultrasound‐guided cannulation 12 . On the other hand, a study evaluated long‐term predictors of survival in patients older than 80 years of age who underwent the CIED procedure 13 . Here, patients with a BMI > 27 kg/m 2 were associated with longer survival than those with a BMI < 21 kg/m 2 13 .…”

Prevalence of depression and its association with quality of life in patients after pacemaker implantation during the COVID-19 pandemic: A network analysis

“…“Appetite” was another symptom directly associated with QOL in the network analysis. Poor appetite is common symptom among older adults as well as those who have pacemaker implantations ( 84 ). Among the potentially relevant appetite changes, digestive problems, sense perception impairments (e.g., loss of taste, smell and/or appetite) and chewing or swallowing difficulties can affect eating and/or food intake, contribute to weight loss and lead to nutritional deficiencies related to lower QOL ( 83 ).…”