Real-World Treatment of Patients With Sinus Node Dysfunction and Heart Failure With Preserved Ejection Fraction

Area of Science:

• Cardiology
• Electrophysiology
• Heart Failure Management

Background:

• Sinus node dysfunction (SND) often necessitates permanent pacemaker (PPM) implantation.
• Heart failure with preserved ejection fraction (HFpEF) complicates PPM decisions due to concerns about worsening heart failure.
• Real-world data on PPM utilization and disease burden in SND patients with coexisting HFpEF is limited.

Purpose of the Study:

• To compare permanent pacemaker (PPM) utilization and disease burden in patients with sinus node dysfunction (SND) and coexisting heart failure with preserved ejection fraction (HFpEF) versus those with SND alone.
• To characterize clinical outcomes in these patient groups within a Medicare population.

Main Methods:

• Retrospective analysis of Medicare administrative claims data.
• Identification of patients diagnosed with SND, stratified by the presence or absence of HFpEF.
• Comparison of clinical outcomes including PPM implant rates, hospitalizations (HF, AF), AV block, heart failure with reduced ejection fraction (HFrEF), myocardial infarction, stroke, and mortality.

Main Results:

• The SND+HFpEF cohort (N=26,986) was older and more female than the SND-only cohort (N=74,269).
• PPM implant rates were significantly lower in the SND+HFpEF group (HR=0.811, p<0.0001).
• SND+HFpEF patients experienced higher rates of HF hospitalizations (HR=2.229), AF hospitalizations (HR=1.174), second/third-degree AV block (HR=1.364), and HFrEF (HR=1.640).

Conclusions:

• Patients with both SND and HFpEF exhibit lower PPM utilization and a higher overall disease burden compared to SND-only patients.
• The findings underscore a potential under-treatment of SND in the presence of HFpEF.
• Further research is needed to optimize treatment pathways for the complex SND+HFpEF patient population.