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      Rehospitalizations for complications and mortality following pacemaker implantation: A retrospective cohort study in an older population

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          Abstract

          <div class="section"> <a class="named-anchor" id="clc23091-sec-0001"> <!-- named anchor --> </a> <h5 class="section-title" id="d7161163e276">Introduction</h5> <p id="d7161163e278">A large number of older people receive pacemakers each year but broad population‐based studies that describe complications following pacemaker implantation in this population are lacking. </p> </div><div class="section"> <a class="named-anchor" id="clc23091-sec-0002"> <!-- named anchor --> </a> <h5 class="section-title" id="d7161163e281">Methods</h5> <p id="d7161163e283">We conducted a retrospective cohort study using data from the Australian Government Department of Veterans' Affairs database. The cohort consisted of patients who received a pacemaker from 2005 to 2014. The outcomes were subsequent rehospitalizations for infections, procedure‐related complications, thromboembolism, cardiovascular events (heart failure, myocardial infarction, and atrial fibrillation), and reoperation of pacemaker, and mortality. </p> </div><div class="section"> <a class="named-anchor" id="clc23091-sec-0003"> <!-- named anchor --> </a> <h5 class="section-title" id="d7161163e286">Results</h5> <p id="d7161163e288">There were 10 883 pacemakers recipients, the median age was 86 years (interquartile range 83‐89), 61% were males, and 74% received a dual‐chamber pacemaker. Within 90 days postdischarge, rehospitalizations were occasioned by pacemaker infection in 0.5%, device‐related complications in 1.5%, cerebral infarction in 0.7%, and heart failure in 6% of single‐chamber pacemaker recipients. In dual‐chamber pacemaker recipients rehospitalizations were occasioned by pacemaker infection in 0.4%, septicemia in 0.4%, device‐related complications in 1.2%, cerebral infarction in 0.3%, and heart failure in 3%. Rehospitalizations for pacemaker adjustment occurred in 1.5% of patients. The 90‐day postdischarge mortality was 5% and 3% in patients with single‐ and dual‐chamber pacemaker, respectively. </p> </div><div class="section"> <a class="named-anchor" id="clc23091-sec-0004"> <!-- named anchor --> </a> <h5 class="section-title" id="d7161163e291">Conclusion</h5> <p id="d7161163e293">Rehospitalizations for infection, procedure‐related complications, or thromboembolism occurred in 1% to 2% of patients within 90 days postdischarge, while 10% of single chamber and 7% of dual‐chamber recipients experienced a rehospitalization for a cardiovascular event. </p> </div>

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          Most cited references22

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          The 11th world survey of cardiac pacing and implantable cardioverter-defibrillators: calendar year 2009--a World Society of Arrhythmia's project.

          A worldwide cardiac pacing and implantable cardioverter-defibrillator (ICD) survey was undertaken for calendar year 2009 and compared to a similar survey conducted in 2005. There were contributions from 61 countries: 25 from Europe, 20 from the Asia Pacific region, seven from the Middle East and Africa, and nine from the Americas. The 2009 survey involved 1,002,664 pacemakers, with 737,840 new implants and 264,824 replacements. The United States of America (USA) had the largest number of cardiac pacemaker implants (225,567) and Germany the highest new implants per million population (927). Virtually all countries showed increases in implant numbers over the 4 years between surveys. High-degree atrioventricular block and sick sinus syndrome remain the major indications for implantation of a cardiac pacemaker. There remains a high percentage of VVI(R) pacing in the developing countries, although compared to the 2005 survey, virtually all countries had increased the percentage of DDDR implants. Pacing leads were predominantly transvenous, bipolar, and active fixation. The survey also involved 328,027 ICDs, with 222,407 new implants and 105,620 replacements. Virtually all countries surveyed showed a significant rise in the use of ICDs with the largest implanter being the USA (133,262) with 434 new implants per million population. This was the largest pacing and ICD survey ever performed, because of mainly a group of loyal enthusiastic survey coordinators. It encompasses more than 80% of all the pacemakers and ICDs implanted worldwide during 2009. ©2011, The Authors. Journal compilation ©2011 Wiley Periodicals, Inc.
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            Incidence and predictors of short- and long-term complications in pacemaker therapy: the FOLLOWPACE study.

            Today quantitative information about the type of complications and their incidence during long-term pacemaker (PM) follow-up is scarce. To assess the incidence and determinants of short- and long-term complications after first pacemaker implantation for bradycardia. A prospective multicenter cohort study (the FOLLOWPACE study) was conducted among 1517 patients receiving a PM between January 2003 and November 2007. The independent association of patient and implantation-procedure characteristics with the incidence of PM complications was analyzed using multivariable Cox regression analysis. A total of 1517 patients in 23 Dutch PM centers were followed for a mean of 5.8 years (SD 1.1), resulting in 8797 patient-years. Within 2 months, 188 (12.4%) patients developed PM complications. Male gender, age at implantation, body mass index, a history of cerebrovascular accident, congestive heart failure, use of anticoagulant drugs, and passive atrial lead fixation were independent predictors for complications within 2 months, yielding a C-index of 0.62 (95% confidence interval 0.57-0.66). Annual hospital implanting volume did not additionally contribute to the prediction of short-term complications. Thereafter, 140 (9.2%) patients experienced complications, mostly lead-related complications (n = 84). Independent predictors for long-term complications were age, body mass index, hypertension, and a dual-chamber device, yielding a C-index of 0.62 (95% confidence interval 0.57-0.67). The occurrence of a short-term PM complication was not predictive of future PM complications. Complication incidence in modern pacing therapy is still substantial. Most complications occur early after PM implantation. Although various patient- and procedure-related characteristics are independent predictors for early and late complications, their ability to identify the patient at high risk is rather poor. This relatively high incidence of PM complications and their poor prediction underscores the usefulness of current guidelines for regular follow-up of patients with PM. Copyright © 2012 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
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              Effects of physiologic pacing versus ventricular pacing on the risk of stroke and death due to cardiovascular causes. Canadian Trial of Physiologic Pacing Investigators.

              Evidence suggests that physiologic pacing (dual-chamber or atrial) may be superior to single-chamber (ventricular) pacing because it is associated with lower risks of atrial fibrillation, stroke, and death. These benefits have not been evaluated in a large, randomized, controlled trial. At 32 Canadian centers, patients without chronic atrial fibrillation who were scheduled for a first implantation of a pacemaker to treat symptomatic bradycardia were eligible for enrollment. We randomly assigned patients to receive either a ventricular pacemaker or a physiologic pacemaker and followed them for an average of three years. The primary outcome was stroke or death due to cardiovascular causes. Secondary outcomes were death from any cause, atrial fibrillation, and hospitalization for heart failure. A total of 1474 patients were randomly assigned to receive a ventricular pacemaker and 1094 to receive a physiologic pacemaker. The annual rate of stroke or death due to cardiovascular causes was 5.5 percent with ventricular pacing, as compared with 4.9 percent with physiologic pacing (reduction in relative risk, 9.4 percent; 95 percent confidence interval, -10.5 to 25.7 percent [the negative value indicates an increase in risk]; P=0.33). The annual rate of atrial fibrillation was significantly lower among the patients in the physiologic-pacing group (5.3 percent) than among those in the ventricular-pacing group (6.6 percent), for a reduction in relative risk of 18.0 percent (95 percent confidence interval, 0.3 to 32.6 percent; P=0.05). The effect on the rate of atrial fibrillation was not apparent until two years after implantation. The observed annual rates of death from all causes and of hospitalization for heart failure were lower among the patients with a physiologic pacemaker than among those with a ventricular pacemaker, but not significantly so (annual rates of death, 6.6 percent with ventricular pacing and 6.3 percent with physiologic pacing; annual rates of hospitalization for heart failure, 3.5 percent and 3.1 percent, respectively). There were significantly more perioperative complications with physiologic pacing than with ventricular pacing (9.0 percent vs. 3.8 percent, P<0.001). Physiologic pacing provides little benefit over ventricular pacing for the prevention of stroke or death due to cardiovascular causes.
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                Author and article information

                Journal
                Clinical Cardiology
                Clin Cardiol
                Wiley
                01609289
                November 2018
                November 2018
                October 19 2018
                : 41
                : 11
                : 1480-1486
                Affiliations
                [1 ]School of Pharmacy and Medical Sciences; The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia; Adelaide South Australia Australia
                [2 ]Department of Clinical Pharmacology, School of Medicine; University of Adelaide; Adelaide South Australia Australia
                [3 ]Centre for Heart Rhythm Disorders; South Australia Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital; Adelaide South Australia Australia
                Article
                10.1002/clc.23091
                6490152
                30294784
                e09c83d3-ee41-49df-98d8-9b0a28179a82
                © 2018

                http://doi.wiley.com/10.1002/tdm_license_1.1

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