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Survival in 1,431 pacemaker patients: prognostic factors and comparison with the general population
V Jelić1, K Belkić, M Djordjević
1Pacemaker Center, University Clinical Center, Belgrade, Yugoslavia.
Insights
Pacemaker patients show high survival rates, with prognosis influenced by pre-existing conditions and post-implantation factors like fatigue. Those without underlying diseases have an excellent long-term outlook.
Area of Science:
- Cardiology
- Medical Devices
- Public Health
Background:
- Pacemaker implantation is a common intervention for heart rhythm disorders.
- Long-term survival data for pacemaker recipients is crucial for understanding prognosis.
- Previous studies may have limited follow-up durations or cohort sizes.
Purpose of the Study:
- To evaluate the long-term survival rates of a large cohort of pacemaker patients.
- To identify factors influencing prognosis before and after pacemaker implantation.
- To compare pacemaker patient mortality with the general population.
Main Methods:
- Retrospective analysis of 1,431 pacemaker patients implanted between 1967 and 1985.
- Long-term follow-up with a minimal loss rate (0.6%).
- Statistical analysis to identify independent prognostic factors.
Main Results:
- Cumulative 10-year survival was 0.7536.
- Pre-implantation factors like coronary heart disease and heart failure impacted survival.
- Post-implantation factors, notably generalized fatigue, significantly affected prognosis.
- Patients without underlying diseases demonstrated excellent 10-year survival (0.9173).
- Elderly males (70+) showed lower mortality than the general population after 1981.
Conclusions:
- Pacemaker implantation is associated with very high short- and long-term survival.
- Prognosis is influenced by a combination of patient demographics, pre-existing conditions, and post-implantation factors.
- Pacemaker patients in good health have an excellent prognosis, regardless of age.
Abstract:
A total of 1,431 patients (mean age 63.4 +/- 14.1) with pacemakers (96.2% VVI) primoimplanted between 1967 and 1985 were followed for a mean duration of 78.2 +/- 40 pacing months, with 0.6% loss to follow-up. Cumulative survival for 1, 3, and 10 years was 0.9427, 0.9136, and 0.7536, respectively. There was no significant difference in survival between atrioventricular block (AVB) and sick sinus syndrome (SSS) patients. In addition to age and gender, factors existent prior to implantation that independently affected prognosis included manifest coronary heart disease (CHD), congenital/acquired heart lesions, heart failure, noncardiac internal disease, syncope, and generalized fatigue. After implantation, the most important factor was generalized fatigue, then age, stroke, myocardial infarct (MI), gender (male), heart failure, and syncope. Patients with no underlying disease showed an extremely high cumulative survival (0.9173 at 10 years). Compared to the general population of Yugoslavia, the pacemaker patients showed a similar yearly mortality rate until 1981. After that, elderly males (70+) had a significantly lower yearly mortality than the matched population. Thus, in this large series of pacemaker patients followed into the most recent period with an extremely low loss to follow-up, short- and long-term survival was very high. Pacemaker patients of any age who are otherwise in good health have an excellent prognosis.