Win-Kuang Shen, MD; David L. Hayes, MD; Stephen C. Hammill, MD; Kent R. Bailey, PhD; David J. Ballard, MD, PhD; Bernard J. Gersh, MB, ChB, DPhil
Shen W, Hayes DL, Hammill SC, Bailey KR, Ballard DJ, Gersh BJ. Survival and Functional Independence after Implantation of a Permanent Pacemaker in Octogenarians and Nonagenarians: A Population-Based Study. Ann Intern Med. 1996;125:476-480. doi: 10.7326/0003-4819-125-6-199609150-00008
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Published: Ann Intern Med. 1996;125(6):476-480.
The number of very elderly persons who are candidates for implantation of a permanent pacemaker is increasing, but the effect of cardiac pacing on long-term survival and functional variables has not been determined.
To determine long-term survival after implantation of a permanent pacemaker in octogenarians and nonagenarians and to assess functional independence after such implantation.
Retrospective, population-based cohort study.
Epidemiologic setting from an unselected population.
157 octogenarians and nonagenarians who initially received a pacemaker between 1962 and 1988 and were followed through 1992.
Overall mortality rate, functional capabilities, and placement in a nursing home.
Observed survival in patients with heart disease was significantly worse than that in age- and sex-matched controls (P < 0.001). Observed survival in community residents without heart disease was similar to that in controls (P > 0.2). Multivariable analysis identified congestive heart failure, chronic obstructive pulmonary disease, old age, syncope, cancer, and atrioventricular block as independent predictors of increased mortality. Symptoms decreased in 118 patients (75%) after pacemaker implantation. After implantation, 70 patients (45%) were permanently placed in nursing homes; this number is similar to the estimated probability of lifetime use of nursing homes from the National Mortality Followback Survey. Dementia developed or worsened in 51 patients (32%), and orthopedic disability occurred in 41 patients (26%).
Normal relative survival in octogenarians and nonagenarians without heart disease is reassuring; the poor prognosis in patients with heart disease warrants careful evaluation of the methods and indications for cardiac pacing. Permanent pacing alleviates bradycardia-related symptoms. Placement in a nursing home and development or worsening of cardiac, neurologic, or orthopedic disabilities frequently occur after implantation of a permanent pacemaker in the very elderly.
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Cardiology, Rhythm Disorders and Devices.
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