SPC365

The role of the Charlson Comorbidity Index in predicting long-term survival after permanent pacemaker implantation – is old age all that matters?

Session: Posters - C. Arrhythmias and Device Therapy
Speaker: João Gameiro

Congress: CPC 2021
Topic: C. Arrhythmias and Device Therapy
Theme: 09. Device Therapy
Subtheme: 09.1 Antibradycardia Pacing
Session Type: Posters
FP Number: ---
Authors: João Gameiro; Simone Costa; Carolina Saleiro; Diana Campos; José Sousa; Ana Rita Gomes; Luís Puga; Eric Monteiro; Gonçalo Costa; Joana Silva; Lino Gonçalves
<p><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Background</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif">An augmented life expectancy and improved therapeutic options have increased the proportion of elderly patients (P) requiring pacemaker (PM) implantation, with &gt;80% of implantations being performed in P aged &gt; 64 years. Although older age is normally associated with longer length of hospital stay and long-term mortality, its predictive capacity is low. The Charlson Comorbidity Index (CCI) predicts mortality and is frequently used for risk stratification in clinical practice, adding age to multiple comorbidities. The prognostic value of the CCI in P submitted to<em><strong>&nbsp;</strong></em>permanent PM implantation is still scarcely known<span style="background-color:white"><span style="color:#70757a">.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Purpose</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif">The purpose of this study is to assess the prognostic value of the CCI in a cohort of P after permanent PM implantation.</span></span></p>

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Methods</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif">A retrospective cohort study from consecutive P submitted to a non-elective permanent PM implantation in our center, between January 2019 and December 2019. Baseline clinical data and in-hospital mortality were determined.</span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif">Receiver operating characteristic (ROC) curves and area under curve (AUC) were calculated. The cut-off value for the CCI was derived from the Youden index.&nbsp; Predictors of long-term mortality and time to the first event were analysed using logistic regression and survival analysis with multivariate Cox regression model.</span></span></p>

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Results</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif">A total of 279 P were included (59.3% male sex, mean age of 78.5 &plusmn; 11). In this cohort, the mean length of stay was 4.6 &plusmn; 6 days<span style="color:#5b9bd5">. </span>In 66.8% of P (n= 187) a dual-chamber PM&nbsp;was implanted. The CCI was calculated for every patient, with a mean value of 5.36 &plusmn; 2. In-hospital mortality was 0.4% in this cohort.</span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif">Long-term mortality in this cohort (with a mean follow-up of 16.8 months) was 12.5%, with 0.8% of P being admitted with an infected device.&nbsp;</span></span><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif">The CCI yielded an acceptable prognostic performance in predicting a longer length of stay using ROC analysis (AUC: 0.572, 95% CI: 0.504-0.640, p = 0.04), performing better than age (AUC: 0.542, 95% CI: 0.474-0.611, p = 0.227). The CCI also yielded a higher prognostic performance in predicting long-term mortality (AUC: 0.672, 95% CI: 0.576 - 0.769, p = 0.001) when compared with age (AUC: 0.639, 95% CI: 0.544 - 0.734, p = 0.008). &nbsp;A CCI &gt; 6 was suggested as a predictive cut-off for higher long-term mortality by the Youden index calculated with this analysis.</span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif">After dividing our cohort in two groups (CCI &gt; 6 and CCI <span style="background-color:white">&le;</span> 6), we used a multivariate Cox regression analysis adjusted to confounding factors (age, gender, pacemaker type and days of hospitalization) that demonstrated a significant statistical impact of a CCI &gt; 6 on long-term mortality (HR adjusted: 2.439, 95% CI: 1.126 &ndash; 5.284.; p = 0.024).</span></span></p>

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Conclusion</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif">The CCI is an easy to calculate tool, with good capacity to predict longer length of stay and long-term mortality in a cohort of P submitted to<em><strong>&nbsp;</strong></em>permanent PM implantation. Older age does not necessary mean worst outcomes and should not be the main clinical concern in this P.</span></span></p>