SPC365

Pacemaker implantation in the elderly: can the patient

Session: Sessão de Posters 15 - Patologias diversas em Cardiologia
Speaker: Jéni Quintal

Congress: CPC 2024
Topic: P. Other
Theme: 37. Miscellanea
Subtheme: 30.5 Cardiovascular Disease in the Elderly
Session Type: Cartazes
FP Number: ---
Authors: Jéni Quintal; Raquel Flores; Sara Gonçalves; Joana Silva Ferreira; Rui Antunes Coelho; Catarina Pohle; Tatiana Duarte; Filipe Seixo
<p style="text-align:justify"><span style="font-size:12pt"><strong><span style="font-size:9.0pt"><span style="color:#1d1d1d">Background:&nbsp;</span></span></strong><span style="font-size:9.0pt"><span style="color:#1d1d1d">Growing life expectancy amplifies cardiovascular disease prevalence, fueling a surge in implantable device use. Ethical and legal questions about the appropriate use, maintenance, and deactivation of such devices in the elderly have been raised but there is scarse data on which patients (pts) would benefit from pacemaker implantation (PMi).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><strong><span style="font-size:9.0pt"><span style="color:#1d1d1d">Aim</span></span></strong><span style="font-size:9.0pt"><span style="color:#1d1d1d">: </span></span><span style="font-size:9.0pt"><span style="color:black">To assess the potential of patient dependency level in activities of daily living (ADLs) as a criteria for elderly patient selection for PMi based on clinical outcomes after PMi.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><strong><span style="font-size:9.0pt"><span style="color:#1d1d1d">Methods</span></span></strong><span style="font-size:9.0pt"><span style="color:#1d1d1d">: We performed a single-center retrospective cohort study. Consecutive</span></span><span style="font-size:9.0pt"><span style="color:black"> pts </span></span><span style="font-size:9.0pt"><span style="color:#1d1d1d">aged </span></span></span><em><span style="font-size:9.0pt"><span style="color:#1d1d1d">=</span></span></em><span style="font-size:12.0pt"> </span><span style="font-size:12pt"><span style="font-size:9.0pt"><span style="color:#1d1d1d">80 years-old (y) who underwent PMi in our center between 1 November 2021 and 1 November 2023 were enrolled (n=211). </span></span><span style="font-size:9.0pt"><span style="color:black">PM generator changes were excluded (n=65). Two groups were formed </span></span><span style="font-size:9.0pt"><span style="color:#1d1d1d">according to pts dependency level for ADLs in Barthel score: active </span></span><span style="font-size:9.0pt"><span style="color:black">pts </span></span><span style="font-size:9.0pt"><span style="color:#1d1d1d">(gA) and </span></span><span style="font-size:9.0pt"><span style="color:black">partial/total dependent pts </span></span><span style="font-size:9.0pt"><span style="color:#1d1d1d">(gB). Baseline characteristics, PMi indication, urgency level, symptoms upon admission, time-lag until PMi, mean in-hospital stay duration, procedural </span></span><span style="font-size:9.0pt"><span style="color:black">and infectious </span></span><span style="font-size:9.0pt"><span style="color:#1d1d1d">complications and all-cause mortality were assessed and compared between the groups. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><strong><span style="font-size:9.0pt"><span style="color:#1d1d1d">Results: </span></span></strong><span style="font-size:9.0pt"><span style="color:#1d1d1d">The study included 146 pts, with a mean age of 86 (</span></span><em><span style="font-size:9.0pt"><span style="color:#1d1d1d">&plusmn;</span></span></em><span style="font-size:12.0pt"> </span><span style="font-size:9.0pt"><span style="color:#1d1d1d">4) y and 53% male prevalence. GA included 111 pts, while gB included 35 (24%) </span></span><span style="font-size:9.0pt"><span style="color:black">pts. </span></span><span style="font-size:9.0pt"><span style="color:#1d1d1d">No significant differences between the groups regarding cardiovascular risk factors were seen - table 1. Dependent pts were more often submitted to urgent PMi (88.6 vs 58.6%, p=0.001). Complete atrioventricular block (AVB) was the main indication for PMi (43.8%), followed by Brady-AFib/Flutter (17.8%), Sinus Node Dysfunction (14.4%), Symptomatic 2<sup>nd</sup> degree AVB (12.3%) and Tachy-Brady Syndrome (6.2%). </span></span><span style="font-size:9.0pt"><span style="color:black">AVB was more frequent in gB (62.9 vs 37.8%, p=0.009). </span></span><span style="font-size:9.0pt"><span style="color:#1d1d1d">Regarding symptoms,</span></span><span style="font-size:9.0pt"><span style="color:black"> s</span></span><span style="font-size:9.0pt"><span style="color:#1d1d1d">yncope was the main complaint in gA (31.5%, p=0.046) and altered state of consciousness the most frequent one in gB (17.1%; p=0.038). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-size:9.0pt"><span style="color:#1d1d1d">Median in-hospital stay duration was 4 (1-79) days with a median time-lag until PMi of 4 days. The length of in-hospital stay was significantly longer in gB &ndash; median 5(1-79) vs 4(1-45) days, p=0.023. Remarkably, infections during hospitalization were far more common in dependent pts (45.7 vs 24.3%, p=0.015), mainly due to nosocomial infections (37.1% gB vs 18.9% gA, p=0.026). During a median follow-up time of 10 (0-25) months, 22 deaths were verified. Mortality was higher in gB (31.4% vs 9.9%; p=0.002), with a median time until death of 2 (0-9) months and a probability of survival of 68.9% &ndash; figure 1.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><strong><span style="font-size:9.0pt"><span style="color:#1d1d1d">Conclusions: </span></span></strong><span style="font-size:9.0pt"><span style="color:#1d1d1d">Our study suggests that PM implantation in pts over 80y with dependence leads to longer hospitalizations with infections and provides no additional mortality benefit compared to active pts. Therefore, criteria selection of elderly who would benefit from PMi should take into account not only patient&rsquo;s frailty and comorbidities but also a patient/family engaged decision according to his autonomy.</span></span></span></p>