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Prognosis after pacemaker implantation in extreme elderly.

Cristina Balla¹, Michele Malagu'¹, Fabio Fabbian²

¹Cardiovascular Center, University of Ferrara, Ferrara, Italy.

European Journal of Internal Medicine

|May 18, 2019

Summary

The Aging in Cardiac Pacing (ACP) Score helps identify elderly patients at high risk of death after pacemaker implantation. This tool aids clinicians in assessing mortality risk in this vulnerable population.

Keywords:

Complications Geriatrics Mortality Pacemaker

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Area of Science:

Cardiology
Geriatrics
Medical Informatics

Background:

Pacemaker (PM) implantation in the extreme elderly (age >80) may yield limited benefits due to significant comorbidities.
A validated short-term mortality risk prediction score is needed to guide clinical decisions in this population.

Purpose of the Study:

To develop and validate the Aging in Cardiac Pacing (ACP) Score for predicting short-term mortality risk in patients over 80 years old undergoing pacemaker implantation.

Main Methods:

Retrospective analysis of 538 patients aged >80 years who received a pacemaker.
Kaplan-Meier survival and multivariable Cox regression analyses to identify predictors of death.
Construction of the ACP Score based on weighted variables with significant hazard ratios.

Main Results:

One, two, and three-year mortality rates were 11%, 21%, and 32%, respectively.
Independent predictors of worse survival included renal failure, active neoplasia, connective tissue disorder, cerebrovascular disease, and single-lead device use.
The ACP Score demonstrated predictive ability (AUC 0.6792) and identified patients with significantly reduced mortality rates when scores were low.

Conclusions:

Significant comorbidities are associated with poorer survival outcomes following pacemaker implantation in the extreme elderly.
The ACP Score serves as a novel tool to identify high-risk patients, potentially optimizing treatment strategies and improving patient selection for pacemaker implantation.