Hospitalization for permanent pacemaker implantation in the context of isolated sinus node dysfunction is associated with increased mortality compared with an outpatient strategy

Sharp, Alexander, Matthews, Gareth ORCID: https://orcid.org/0000-0001-8353-4806, Papageorgiou, Nikolaos, Till, Richard, Raine, Daniel, Williams, Ian, Grahame-Clarke, Cairistine, Nair, Santosh, Abdul-Samad, Omar, Vassiliou, Vassilios ORCID: https://orcid.org/0000-0002-4005-7752, Garg, Pankaj ORCID: https://orcid.org/0000-0002-5483-169X and Lim, Wei Yao (2023) Hospitalization for permanent pacemaker implantation in the context of isolated sinus node dysfunction is associated with increased mortality compared with an outpatient strategy. PACE - Pacing and Clinical Electrophysiology, 46 (12). pp. 1465-1471. ISSN 0147-8389

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Abstract

Background: Permanent pacemaker (PPM) implantation is a well-established treatment for symptomatic sinus node dysfunction (SND). The optimal timing of this intervention is unclear, with atrioventricular blocks often prioritized in resource stressed waiting lists due to mortality concerns. Methods: Mortality data was compared between patients receiving elective outpatient (OP) PPM implantation, and those presenting to hospital for urgent inpatient (IP) management for symptomatic SND. Survival analysis was conducted using Kaplan-Meier plots and compared using the log-rank test. Univariable and multivariable Cox regression, as well as propensity score matching analyses were performed to assess the prognostic effect on 30-day and 1-year all-cause mortality of inpatient implant. Results: Of the 1269 patients identified with isolated SND, 740 (58%) had PPMs implanted on an OP and 529 (42%) on an IP basis. Mortality was significantly worse in patients where management was driven by hospital admission on an urgent basis (Log-Rank χ2 = 21.6, p < 0.001) and remained an independent predictor of 1-year all-cause mortality (HR 3.40, 95% CI 1.97–5.86, p < 0.001) on multivariable analysis. Conclusions: SND is predominantly a disease associated with ageing and comorbid populations, where avoidance of deconditioning, hospitalization acquired infections, and polypharmacy is advantageous. Admission avoidance is therefore the preferable strategy.

Item Type: Article
Additional Information: Funding Information: The authors have no competing interests to declare that are relevant to the content of this article. More generally, AS receives funding from Acutus Medical. GM is funded by the National Institute of Health Research (NIHR). VV receives funding from the British Heart Foundation, Wellcome Trust, NIHR, B Braun, Medtronic and Norfolk Heart Trust. PG receives funding from the Wellcome Trust, and is a is a clinical advisor for Pie Medical Imaging and Medis Medical Imaging.
Uncontrolled Keywords: admission avoidance,aging,frailty,permanent pacemaker,sick sinus syndrome,dysfunction,cardiology and cardiovascular medicine ,/dk/atira/pure/subjectarea/asjc/2700/2705
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 17 Jan 2024 01:37
Last Modified: 17 Jan 2024 01:37
URI: https://ueaeprints.uea.ac.uk/id/eprint/94188
DOI: 10.1111/pace.14856

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