Association of Neighborhood Income With In-Hospital Outcomes After Leadless Pacemaker Implantation: A National...

Area of Science:

• Cardiovascular Medicine
• Health Economics
• Health Outcomes Research

Background:

• Leadless pacemakers (LPMs) offer advantages by eliminating transvenous leads and subcutaneous pockets, potentially reducing related complications.
• The relationship between socioeconomic status, specifically neighborhood income, and in-hospital outcomes following LPM implantation remains incompletely understood.

Purpose of the Study:

• To investigate the association between ZIP-code-based median household income and in-hospital outcomes after LPM implantation in the United States.
• To identify potential disparities in care or outcomes related to socioeconomic factors in patients receiving LPMs.

Main Methods:

• Analysis of the National Inpatient Sample (2018-2022) to identify adult LPM implantations, using discharge weights for national estimates.
• Stratification of admissions into four income quartiles (Q1 lowest to Q4 highest) based on ZIP-code median household income.
• Multivariable logistic regression was employed to assess adjusted odds ratios for various in-hospital outcomes, controlling for demographic, comorbidity, payer, and hospital region variables.

Main Results:

• Patients in the lowest income quartile (Q1) exhibited higher crude mortality rates.
• After adjustment, the second quartile (Q2) showed increased odds of in-hospital death compared to Q1.
• Higher income quartiles (Q4) were associated with increased odds of pericardial complications but decreased odds of bleeding and transfusion.
• Venous thromboembolism events were more frequent in Q2 and Q4 compared to Q1.
• Median hospital charges were highest in Q4, while Q1 experienced a longer median length of stay.

Conclusions:

• Neighborhood income demonstrates endpoint-specific associations with in-hospital outcomes following leadless pacemaker implantation.
• These findings highlight the influence of socioeconomic factors on patient outcomes and may inform peri-procedural counseling and institutional review processes.