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Prevalence of diabetes in elderly patients requiring permanent cardiac pacemaker insertion
J T Lear1, I G Lawrence, A C Burden
1Leiceister General Hospital, UK.
Insights
Diabetic patients have a 34% higher risk of needing a permanent cardiac pacemaker insertion, particularly after myocardial infarction. This increased risk highlights a significant link between diabetes mellitus and cardiac conduction abnormalities.
Area of Science:
- Cardiology
- Endocrinology
- Epidemiology
Background:
- Diabetes mellitus is associated with increased cardiovascular complications.
- Diabetic patients exhibit a higher incidence of atrioventricular block and right bundle branch block post-myocardial infarction.
Purpose of the Study:
- To investigate if diabetic individuals are more likely to require permanent cardiac pacemaker insertion.
- To quantify the association between diabetes and pacemaker implantation.
Main Methods:
- A capture-recapture technique was employed using Hospital Activity Analysis data and ward admission/case notes.
- Diabetes coding accuracy was verified via a central register and case note analysis.
- A reference population was established through a market town survey for control data.
Main Results:
- Among 688 patients undergoing pacemaker insertion (79% >65 years), 11.1% were diabetic.
- In the same age group, 8.3% of controls were diabetic, yielding a relative risk of 1.34 (P < 0.01).
- The observed relative risk is considered an underestimate of the true association.
Conclusions:
- Diabetic patients demonstrate a significantly elevated risk for requiring permanent cardiac pacemaker insertion.
- The excess risk is likely attributable to ischemic heart disease, with potential contributions from microangiopathy or cholinergic sensitivity.
Abstract:
Diabetes mellitus increases the rate of atrioventricular block after a myocardial infarction; right bundle branch block is more common than expected in the diabetic outpatient population. We decided to assess whether diabetic subjects were more likely to need permanent cardiac pacemaker insertion. Data from patients in Leicestershire who had undergone permanent cardiac pacemaker insertion during a 4-year period were analysed. The capture recapture technique was used: Hospital Activity Analysis data as capture, ward admission book and case note confirmation as recapture. Diabetes coding accuracy was confirmed from the central register and from an analysis of 100 sets of case notes. The number of these patients with diabetes was then recorded. Data for the reference population was obtained using a survey of a market town in Leicestershire. There were 688 patients, most (79%) aged over 65 years. Our analysis was performed on this group. Of this age group undergoing pacemaker insertion. 11.1% was diabetic. In the same age group, 8.3% of the controls were diabetic: a relative risk of 1.34 (P < 0.01, 95% confidence interval 1.25-1.44). This relative risk is likely to be an underestimate. The aetiology of this excess risk is uncertain: it is most likely due to ischaemic heart disease, but microangiopathy or increased cholinergic sensitivity may play a role.