Abstract 306: Pacemaker Implantation in Nonagenarians is Safe
Introduction: The number and proportion of nonagenarians in the US is increasing dramatically. Data are scarce on outcomes of pacemaker implantation in the very elderly, limiting the ability of physicians and patients to make informed decisions.
Hypothesis: We hypothesized that increasing age is associated with worse in-hospital outcomes (mortality and complications) in the elderly.
Methods: Patients ≥ 70 years with a new pacemaker implant were identified in the 2004-2008 HCUP-Nationwide Inpatient Sample, the largest all-payor inpatient database in the US. Patient demographic and clinical variables, including an age-independent Charlson comorbidity index, as well as hospital characteristics were analyzed. Clinical outcomes were in-hospital mortality and complications (identified through ICD-9 codes) including pneumothorax, tamponade, device infection, hematoma, and acute renal failure/new hemodialysis. Unadjusted outcomes were compared using χ² and Mantel-Haenszel tests. Multivariate hierarchical logistic models were created to adjust for case-mix variation and clustering of cases within hospitals.
Results: Among 115,683 patients (mean age 81.47 years; SEM 0.02), patients ≥ 90 years were less likely to be male, to have mild comorbidity, and to have elective procedures (Table). Unadjusted mortality and complication rates were higher with increasing age although absolute differences were small (Table). Multivariable analysis revealed severe comorbidity (OR 5.00; 95% CI 4.05-6.17) and nonelective admission (OR 3.09; CI 2.46-3.88) were greater predictors of mortality than increasing age (OR 2.81; CI 2.35-3.35), all p<0.0001. For complications, severe comorbidity (OR 1.35; CI 1.20-1.51) and female gender (OR 1.35; CI 1.28-1.42) were larger predictors than increasing age (OR 1.07; CI 1.01-1.13), all p<0.02.
Conclusions: This is the largest study to date examining outcomes of pacemaker implantation among nonagenarians. Although increasing age is a predictor of worsening outcomes in the elderly, the absolute rates are modest, even in nonagenarians, and other factors are more important predictors than age.
- © 2012 by American Heart Association, Inc.