Significance of asymptomatic bradycardia for subsequent pacemaker implantation and mortality in patients >60 years of age

Jeffrey Goldberger, Nils P. Johnson, Claudia Gidea

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Sinus bradycardia may be more significant in older patients than in a younger group because it could signal important or advanced conduction system and/or cardiac disease potentially modifiable with pacemaker implantation. We evaluated the clinical need for subsequent pacemaker implantation and mortality rate in outpatients >60 years of age with relatively asymptomatic bradycardia (heart rate <55 beats/min without a subsequent pacemaker implantation within 2 weeks) or not (heart rate 60 to 70 beats/min). The 2 groups were matched against pacemaker implantation and death records but without data on indication or cause. KaplanMeier survival curves and univariate and multivariable models examined pacemaker implantation and all-cause mortality. The cohort consisted of 470 patients with and 2,090 without asymptomatic bradycardia. Mean follow-up period was 7.2 ± 2.9 years during which 137 patients (5.4%) underwent pacemaker implantation and 748 (29.2%) died. Incidence of pacemaker placement was higher in the bradycardia cohort (9% vs 5%, p <0.001). The higher incidence of pacemaker implantation did not appear in the first 4 years. Univariate analysis showed no increase in mortality in the bradycardia group (hazard ratio 0.87, 95% confidence interval 0.72 to 1.04, p = 0.130), whereas multivariable analysis showed protection (hazard ratio 0.78, 95% confidence interval 0.65 to 0.94, p = 0.010). In conclusion, older patients with asymptomatic bradycardia have a very low rate of pacemaker implantation, annualized to <1% per year. Their higher rate of pacemaker implantation compared to outpatients without bradycardia shows a latency period of approximately 4 years. It has no adverse impact on all-cause mortality and may even be protective.

Original languageEnglish (US)
Pages (from-to)857-861
Number of pages5
JournalAmerican Journal of Cardiology
Volume108
Issue number6
DOIs
StatePublished - Sep 15 2011
Externally publishedYes

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Bradycardia
Mortality
Outpatients
Heart Rate
Confidence Intervals
Death Certificates
Incidence
Heart Diseases
Research Design
Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Significance of asymptomatic bradycardia for subsequent pacemaker implantation and mortality in patients >60 years of age. / Goldberger, Jeffrey; Johnson, Nils P.; Gidea, Claudia.

In: American Journal of Cardiology, Vol. 108, No. 6, 15.09.2011, p. 857-861.

Research output: Contribution to journalArticle

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abstract = "Sinus bradycardia may be more significant in older patients than in a younger group because it could signal important or advanced conduction system and/or cardiac disease potentially modifiable with pacemaker implantation. We evaluated the clinical need for subsequent pacemaker implantation and mortality rate in outpatients >60 years of age with relatively asymptomatic bradycardia (heart rate <55 beats/min without a subsequent pacemaker implantation within 2 weeks) or not (heart rate 60 to 70 beats/min). The 2 groups were matched against pacemaker implantation and death records but without data on indication or cause. KaplanMeier survival curves and univariate and multivariable models examined pacemaker implantation and all-cause mortality. The cohort consisted of 470 patients with and 2,090 without asymptomatic bradycardia. Mean follow-up period was 7.2 ± 2.9 years during which 137 patients (5.4{\%}) underwent pacemaker implantation and 748 (29.2{\%}) died. Incidence of pacemaker placement was higher in the bradycardia cohort (9{\%} vs 5{\%}, p <0.001). The higher incidence of pacemaker implantation did not appear in the first 4 years. Univariate analysis showed no increase in mortality in the bradycardia group (hazard ratio 0.87, 95{\%} confidence interval 0.72 to 1.04, p = 0.130), whereas multivariable analysis showed protection (hazard ratio 0.78, 95{\%} confidence interval 0.65 to 0.94, p = 0.010). In conclusion, older patients with asymptomatic bradycardia have a very low rate of pacemaker implantation, annualized to <1{\%} per year. Their higher rate of pacemaker implantation compared to outpatients without bradycardia shows a latency period of approximately 4 years. It has no adverse impact on all-cause mortality and may even be protective.",
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