Incidence and Prognostic Implications of Mental Disorders Among Patients With a Permanent Pacemaker: A Nationwide...

The burden of mental disorders among patients with permanent pacemakers (PPMs) and their impact on long-term outcomes remain poorly understood. We aimed to investigate the incidence of newly diagnosed mental disorders among PPM patients and to evaluate their prognostic implications.

From the Korean National Health Insurance Service database, we identified 19 746 patients who underwent PPM implantation and 58 642 propensity score-matched controls without a PPM between 2010 and 2020. Among PPM patients, long-term clinical outcomes were compared according to the presence of newly diagnosed mental disorders.

The 10-year cumulative incidence of any newly diagnosed mental disorders among PPM patients was 45.1%. The most common mental disorders were depressive disorder (24.6%), insomnia (20.6%), and anxiety disorder (5.6%). The overall risk of detecting new mental disorders among PPM patients was similar to that of the matched general population (hazard ratio [HR], 0.98 [95% CI, 0.96-1.01]). However, male PPM patients showed a significantly higher risk, particularly those aged <50 years (HR, 1.42 [95% CI, 1.16-1.75]) and those aged 50 to 59 years (HR, 1.20 [95% CI, 1.04-1.38]). PPM patients diagnosed with any mental disorder had a significantly higher 10-year cumulative all-cause mortality compared with those without mental disorders (53.6% versus 31.3%; HR, 1.71 [95% CI, 1.61-1.82]), with the highest risk observed in patients with schizophrenia (HR, 3.23 [95% CI, 2.61-4.00]). Adverse outcomes were more pronounced in male patients and when mental disorders were diagnosed early after implantation (within 3.2 years).

Although the risk of detecting new mental disorders among PPM patients was comparable to that of the matched non-PPM population, newly diagnosed mental disorders were associated with increased long-term mortality in PPM patients, particularly in younger men and those with early-onset mental disorders.