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Identifying independent risk factors of mortality among patients receiving a leadless pacemaker: A longitudinal
Shreya Srivastava1, Humail Patel1, Riya George1
1Department of Medicine, Northwell, New Hyde Park, New York.
Insights
Higher Charlson Comorbidity Index (CCI) scores in patients receiving leadless pacemakers (LPs) are linked to increased mortality risk. Advanced age, low ejection fraction, and hemoglobin levels also predict early mortality in LP recipients.
Area of Science:
- Cardiology
- Medical Devices
- Health Outcomes Research
Background:
- Leadless pacemakers (LPs) show promise in certain subgroups, but conflicting data exists regarding their mortality and complication rates compared to traditional pacing.
- Previous studies often rely on claims data, limiting detailed clinical factor analysis.
- This study addresses these limitations through a single-center, retrospective analysis of clinical factors influencing mortality in LP patients.
Purpose of the Study:
- To investigate clinical factors, specifically the Charlson Comorbidity Index (CCI), associated with higher mortality in patients who received leadless pacemakers (LPs).
- To identify independent predictors of both overall and early (30-day) mortality among LP recipients.
Main Methods:
- Retrospective analysis of 574 patients who received an LP between 2018 and 2022.
- Calculation of Charlson Comorbidity Index (CCI) for each patient.
- Multivariable Cox and logistic regression analyses to determine hazard ratios and odds ratios for mortality predictors.
Main Results:
- The mean CCI was 5.30, with an overall mortality of 26.6%.
- A CCI >4 significantly increased mortality risk (HR 3.04; 95% CI 1.70-5.42) and decreased 30-day survival odds.
- Independent risk factors for early mortality included low left ventricular ejection fraction (OR 2.62), low hemoglobin (OR 2.29), and advanced age (OR 2.28).
Conclusions:
- The Charlson Comorbidity Index (CCI) is a significant predictor of mortality in patients receiving leadless pacemakers (LPs).
- A CCI score greater than 4 is independently associated with increased mortality risk.
- Low left ventricular ejection fraction, low hemoglobin, and advanced age are critical factors predicting early mortality in LP patients.
Background:
In certain high-risk subgroups, leadless pacemakers (LPs) have lower 2-year complications and reintervention rates than transvenous-VVI pacing. Despite this, other studies have reported higher all-cause in-hospital mortality and complications in the LP group. Many of these studies are based on claims data, which have inherent limitations. We conducted a single-center, detailed, retrospective study to examine clinical factors, including the Charlson comorbidity index (CCI), associated with higher mortality among patients receiving an LP.
Objective:
This study aimed to examine clinical factors, including the CCI, associated with higher mortality among patients receiving an LP.
Methods:
A retrospective analysis was conducted among 574 patients who received an LP between 2018 and 2022 at a quaternary care hospital. CCI was generated for each patient, and a multivariable Cox regression analysis was performed to obtain associated hazard ratios. Furthermore, we conducted logistic regression analyses to identify unique factors that affect the odds of 30-day mortality.
Results:
The mean CCI score in the study population was 5.30 (standard deviation 2.03). The total mortality in the study population was 26.6% (n = 146). Patients who had a CCI of >4 points had a 3-fold increase in risk of mortality compared with those who had a CCI of ≤4 points (hazard ratio 3.04; 95% confidence interval [CI] 1.70-5.42). Moreover, there was a decreased odds of survival within the first 30 days among those with a CCI of >4. Low left ventricular ejection fraction (odds ratio [OR] 2.62; 95% CI 1.05-6.56), hemoglobin (OR 2.29; 95% CI 1.10-4.77), and advanced age (OR 2.28; 95% CI 1.20-4.34) were identified as independent risk factors of early mortality.
Conclusion:
CCI has previously been demonstrated to be a significant predictor of mortality in patients receiving pacemakers or implantable defibrillators. In our study, we found that a CCI of >4 was independently associated with mortality. In addition, our study highlights that low left ventricular ejection fraction, hemoglobin, and advanced age are key risk factors that may predict early mortality among LP patients.
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