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Circulation

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Clinical Articles, Lead Article

Pacing in the elderly – comorbidities predict complication rates

Increasing age predicts worsening outcomes with pacing in the elderly. However, absolute mortality and complication rates are modest, even in nonagenarians, and comorbidity is a stronger predictor than age, according to a study1 published recently in Circulation.

Researchers identified 115,683 patients ≥70 years who underwent initial pacemaker (PM) implantation in the 2004–2008 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. Outcomes included in-hospital mortality, complications, length of stay and charges. Unadjusted outcomes were compared using χ² and Mantel-Haenszel tests.

Multivariate hierarchical logistic models and stepwise linear regression models adjusted for case-mix variation and clustering. 11% (12,917) were ≥90. Relative to patients 70–79 years, patients ≥90 were more likely to have moderate/severe comorbidity (Charlson score >1; 43.2% vs. 40.1%) and less likely to be admitted electively (17.5% vs. 29.9%), all p<0.001.

The unadjusted mortality and complication rates in patients 70–79 years were 0.60% and 5.61%, respectively, and in patients ≥90 years were 1.87% and 6.31%. Length of stay and charges in patients 70–79 years were 3.22 days and $38,871, and in patients ≥90 years, 4.27 days and $41,373.

Multivariable analysis revealed severe comorbidity (OR 5.00; 95% CI, 4.05-6.17) was a greater predictor of mortality than increasing age (OR 2.81 per decade; CI 2.35-3.35), all p<0.001. Similarly, severe comorbidity (Charlson score ≥5) was more strongly associated with complications, length of stay, and charges than age.

References

1. Mandawat A, Curtis JP, Mandawat A, Njike VY, Lampert R. Safety of pacemaker implantation in nonagenarians: an analysis of the healthcare cost and utilization project-nationwide inpatient sample. Circulation 2013. http://dx.doi.org/10.1161/​CIRCULATIONAHA.113.001434

Published on: March 27, 2013

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