Sex differences in rates of permanent pacemaker implantation and in-hospital complications: A statewide cohort study of over 7 million persons from 2009–2018

Abstract

Background Whether a bias exists in the implantation of permanent pacemakers (PPI) and complications according to sex and age in the Australian population is unclear. Hypothesis Population rate of PPI and its complications differed between men and women. Methods We examined the prevalence of PPI from January-2009 to December-2018 from datasets held by the New South Wales (NSW) Centre-for-Health-Record-Linkage, including patient’s characteristics and in-hospital complications. All analysis was stratified by sex and age by decade. Results A total of 28,714 admissions involved PPI (40% women). The mean PPI rate (±standard-deviation) and median age (interquartile range) was 2,871±242 per-annum and 80yrs (73-86yrs), respectively. At the same time-period, the mean NSW population size was 7,487,393±315,505 persons (50% women; n = 3,773,756±334,912). The mean annual age-adjusted rate of PPI was 125.5±11.6 per-100,000-men, compared to 63.4±14.3 per-100,000-women (P<0.01). The mean annual rate of PPI increased from 2009–2017 by 0.9±3.3% in men, compared to 0.4±4.4% in women (P<0.01) suggesting a widening disparity. Total non-fatal in-hospital complications was higher in women compared to men (8.2% vs 6.6%, P<0.01), and this persisted throughout study period even after adjusting for multiple covariates. Overall, in-hospital mortality was low (0.73%) and similar between sexes. Conclusion In a statewide Australian population exceeding 7 million, PPI rates were consistently nearly two-fold higher for men compared to women over 10-years, with an apparently widening disparity, that was not explained by age. Overall complication rates were higher in women. Future studies should examine the aetiology behind this disparity in PPI rates, as well as its complications.

Assessment of Trend, Indication, Complications, and Outcomes of Pacemaker Implantation in Adult Patients at Tertiary Hospital of Ethiopia: Retrospective Follow Up Study

“…We reported an upper limb DVT rate of 1.7%, which was lower than studies conducted in Brazil (6%) and Iran (21%), but was greater than the one from Australia (0.15%). 10 , 29 , 30 Prior reports used different imaging modality approaches, and types of cardiac rhythm management devices, which could be the cause of this significant variation in studies results.…”

“…Our study found a death rate that was higher than studies conducted in Australia (0.73%), Iraq (0%), the USA (0.08%), and Kenya (0.0%), but lower than those conducted in Senegal (1.2%), Spain (5.2%), and France (3.9%). 9 , 10 , 13 , 15 , 20 , 23 , 33 …”

“…Studies conducted in the USA and Australia that were similar to ours showed an association between sex and complications related to pacemakers. 10 , 22 Because they have smaller veins, thin vessel walls, a smaller right ventricle, and less tissue between the subclavian vein and pleura, females are more likely to experience complications from pacemakers.…”

“…We identified also the most common pacemaker-related complications as Studies that looked at the magnitude of complications related to pacemaker implantation found that the rate of complications ranged from 3.6% to 21.6%. [8][9][10][11][12][13][14][15][16][17] Variations in patient sociodemographic factors among studies, patient volumes, and Centre-to-Centre differences in experience levels may all account for this heterogeneity in the rate of complications. In comparison to studies conducted in Norway, Australia, Germany, the United States, Iraq, Senegal, Cameroon, and Ghana, which showed complication rates of 12%, 7.2%, 3%, 4.2%, 4.25%, 3.9%, 9.7%, and 7%, respectively, this study's complication rate of 15.3% is greater.…”

The Appropriateness of Medical Devices Is Strongly Influenced by Sex and Gender

“…The survival at 30 years on from the implantation of permanent pacemakers seems to be higher in women than in men but no univocal data are available on life quality [28]. Periprocedural side effects (pneumothorax, cardiac perforation, and pocket hematoma) occur more frequently in women than in men [92,166] and, vice-versa, infective complications seem to be more frequent in men, but the data are non-univocal [28]. One reason could be the fact that women receive a pacemaker at an older age and for a longer time, given their longer life expectancy [92,166].…”