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Survival and Functional Independence after Implantation of a Permanent Pacemaker in Octogenarians and Nonagenarians: A Population-Based Study

Win-Kuang Shen, MD; David L. Hayes, MD; Stephen C. Hammill, MD; Kent R. Bailey, PhD; David J. Ballard, MD, PhD; and Bernard J. Gersh, MB, ChB, DPhil
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From the Mayo Clinic and Mayo Foundation, Rochester, Minnesota. Requests for Reprints: Win-Kuang Shen, MD, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. Current Author Addresses: Drs. Shen, Hayes, and Hammill: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;125(6):476-480. doi:10.7326/0003-4819-125-6-199609150-00008
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Background: 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.

Objective: To determine long-term survival after implantation of a permanent pacemaker in octogenarians and nonagenarians and to assess functional independence after such implantation.

Design: Retrospective, population-based cohort study.

Setting: Epidemiologic setting from an unselected population.

Patients: 157 octogenarians and nonagenarians who initially received a pacemaker between 1962 and 1988 and were followed through 1992.

Main Outcome Measures: Overall mortality rate, functional capabilities, and placement in a nursing home.

Results: 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%).

Conclusions: 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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Figure 1. Expected survival was estimated from age- and sex-matched controls in the population of Minnesota in 1980. The study sample ( < 0.001). Patients with heart disease ( < 0.001). Patients without heart disease ( > 0.2).
Observed survival after pacemaker implantation in octogenarians and nonagenarians from Olmsted County, Minnesota, between 1962 and 1988.Top.PMiddle.PBottom.P
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