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Temporal trends in permanent pacemaker implantation: a population-based study
Daniel Z Uslan1, Imad M Tleyjeh, Larry M Baddour
1Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA. duslan@mednet.ucla.edu
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.
Insights
Permanent pacemaker (PPM) implantation incidence significantly increased over 30 years. PPM recipients also showed a rise in comorbidities, independent of age, particularly in the last 15 years.
Area of Science:
- Cardiology
- Epidemiology
- Medical Devices
Background:
- Limited data exist on temporal trends in permanent pacemaker (PPM) implantation.
- Understanding these trends is crucial for healthcare planning and resource allocation.
Purpose of the Study:
- To describe trends in the incidence of PPM implantation over a 30-year period.
- To assess changes in comorbidities among PPM recipients.
Main Methods:
- Retrospective population-based cohort study of 1291 adult residents in Olmsted County, Minnesota (1975-2004).
- Analysis of PPM implantation incidence, pacing modes, indications, and comorbidities using the Charlson Comorbidity Index (CCI).
- Comparison of PPM recipients with age- and sex-matched PPM-free controls.
Main Results:
- Adjusted PPM implantation incidence rose from 36.6 to 99 per 100,000 person-years between 1975-1979 and 2000-2004 (P < .0001).
- PPM recipients exhibited a higher CCI than controls (P = .04), with a notable increase in mean CCI since 1990.
- Age-adjusted mean CCI increased from 3.15 to 4.60 in PPM recipients (P < .0001).
Conclusions:
- Significant increases in PPM implantation incidence observed over three decades.
- PPM recipients experienced an age-independent increase in comorbidities, particularly in the last 15 years.
- Findings highlight evolving patient profiles and comorbidity burdens in pacemaker recipients.
