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Comparative Study
. 2008 May;155(5):896-903.
doi: 10.1016/j.ahj.2007.12.022. Epub 2008 Feb 19.

Temporal trends in permanent pacemaker implantation: a population-based study

Daniel Z Uslan  1 , Imad M Tleyjeh, Larry M Baddour, Paul A Friedman, Sarah M Jenkins, Jennifer L St Sauver, David L Hayes
Affiliations
Comparative Study

Temporal trends in permanent pacemaker implantation: a population-based study

Daniel Z Uslan et al. Am Heart J. 2008 May.

Abstract

Background: Limited data exist regarding temporal trends in permanent pacemaker (PPM) implantation. To describe trends in incidence and comorbidities of PPM recipients, we conducted a retrospective population-based cohort study over a 30-year period.

Methods: All 1291 adult residents of Olmsted County, Minnesota, undergoing PPM implantation between 1975 and 2004 were included in the study. Trends in PPM implantation incidence, pacing mode and indication, and comorbidities (via Charlson Comorbidity Index [CCI]) were assessed through the Rochester Epidemiology Project. Permanent pacemaker recipients were compared with age- and sex-matched PPM-free controls from the population.

Results: Adjusted implantation incidence rates increased from 36.6 per 100,000 person-years during 1975 to 1979 to 99 per 100,000 person-years during 2000 to 2004 (P < .0001). After adjusting for age (hazard ratio [HR] 1.06 per year), male sex (HR 1.28), and implant year (HR 0.98), the HR for death among PPM recipients by CCI quartiles was 1.0, 1.79, 2.29, and 3.91 for CCI of 0 to 1 (reference), 2 to 3, 4 to 6, and > or = 7, respectively (P < .0001). Overall, PPM recipients had higher CCI than the population-based controls (P = .04), with higher mean CCI noted since 1990. Mean age-adjusted CCI increased from 3.15 to 4.60 among the cases (P < .0001) and from 3.06 to 3.54 among the age- and sex-matched controls (P = .047).

Conclusions: There have been significant increases in incidence of PPM implantation over 30 years, and PPM recipients have had an age-independent increase in comorbidities relative to the underlying population, especially over the past 15 years.

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Figures

Figure 1
Figure 1
PPM implant incidence in Olmsted Co. MN by sex, 1975-2004 (age adjusted to US White, year 2000 population)
Figure 2
Figure 2
PPM implant incidence in Olmsted Co. MN by age, 1975-2004 (sex adjusted to US white, year 2000 population)
Figure 3
Figure 3
Trends in single versus dual-chamber pacing mode
Figure 4
Figure 4
Trends in indication for pacemaker placement SND, Sinus node dysfunction; CSH, carotid sinus hypersensitivity; BCD, bilevel conduction disturbance (sinus node dysfunction plus atrioventricular block); AVB, atrioventricular block. Patients receiving PPM for congestive heart failure or hypertrophic cardiomyopathy (<3% of the total) are not shown.
Figure 5
Figure 5
Survival by Charlson Index Quartile, (n=1128)
Figure 6
Figure 6
Trends in Charlson Comorbidity Index, Cases vs. Controls, adjusted for age at implant. The p-values above each set of data points represent pairwise comparisons between cases and controls. Intra-group comparisons were analyzed with an age-adjusted ANOVA model. The overall p-value comparing the Charlson Index least squares mean for PPM recipients versus controls was 0.04.
See this image and copyright information in PMC

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