In the Journals

Permanent pacemaker after TAVR confers elevated morbidity, mortality

Among patients who underwent transcatheter aortic valve replacement, those who had a pacemaker permanently implanted at index hospitalization had greater morbidity and mortality than those who did not, researchers reported.

However, pacemaker status did not significantly affect cumulative health care costs at 1 year.

Talal Aljabbary, MD, MSc, from the Institute for Clinical Evaluation Sciences in Toronto and Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, and colleagues retrospectively analyzed 1,263 patients (mean age, 82 years; 47% women) from a multicenter registry who underwent TAVR in Ontario, Canada, between April 2010 and March 2015. Immediate postprocedural in-hospital deaths were excluded.

Among the cohort, 14.7% required permanent pacemaker implantation during the index hospitalization. Outcomes of interest were all-cause mortality, readmission, readmission for HF and ED visits at a mean follow-up of 990 days; and cumulative health care costs at 1 year.

The researchers performed propensity score weighting to adjust for baseline differences between those who received a permanent pacemaker and those who did not.

After adjustment, Aljabbary and colleagues found permanent pacemaker implantation was associated with higher rates of the following:

all-cause mortality (43.9% vs. 31.7%; HR = 1.4; 95% CI, 1.01-1.94);

all-cause readmission (80.9% vs. 70.6%; HR = 1.28; 95% CI, 1.15-1.43);

HF readmission (33.9% vs. 19.1%; HR = 1.9; 95% CI, 1.53-2.36); and

ED visits (95.5% vs. 87.3%; HR = 1.28; 95% CI, 1.08-1.52).

Median length of stay from TAVR admission to discharge and from TAVR procedure to discharge was longer in those who required a pacemaker (P < .001 for both).

Cumulative 1-year postdischarge health care costs did not significantly differ between the groups (cost ratio = 1.18; 95% CI, 0.91-1.37), according to the researchers.

“We postulate that this lack of statistical significance may be due to our study being underpowered given the wide variation associated with cost data; alternatively, it may be due to the increased mortality in the [permanent pacemaker] group, which reduced the overall follow-up on average for patients with a [permanent pacemaker], and thus cumulative costs,” Aljabbary and colleagues wrote. – by Erik Swain

Disclosure s : Aljabbary reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Among patients who underwent transcatheter aortic valve replacement, those who had a pacemaker permanently implanted at index hospitalization had greater morbidity and mortality than those who did not, researchers reported.

However, pacemaker status did not significantly affect cumulative health care costs at 1 year.

Talal Aljabbary, MD, MSc, from the Institute for Clinical Evaluation Sciences in Toronto and Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, and colleagues retrospectively analyzed 1,263 patients (mean age, 82 years; 47% women) from a multicenter registry who underwent TAVR in Ontario, Canada, between April 2010 and March 2015. Immediate postprocedural in-hospital deaths were excluded.

Among the cohort, 14.7% required permanent pacemaker implantation during the index hospitalization. Outcomes of interest were all-cause mortality, readmission, readmission for HF and ED visits at a mean follow-up of 990 days; and cumulative health care costs at 1 year.

The researchers performed propensity score weighting to adjust for baseline differences between those who received a permanent pacemaker and those who did not.

After adjustment, Aljabbary and colleagues found permanent pacemaker implantation was associated with higher rates of the following:

all-cause mortality (43.9% vs. 31.7%; HR = 1.4; 95% CI, 1.01-1.94);

all-cause readmission (80.9% vs. 70.6%; HR = 1.28; 95% CI, 1.15-1.43);

HF readmission (33.9% vs. 19.1%; HR = 1.9; 95% CI, 1.53-2.36); and

ED visits (95.5% vs. 87.3%; HR = 1.28; 95% CI, 1.08-1.52).

Median length of stay from TAVR admission to discharge and from TAVR procedure to discharge was longer in those who required a pacemaker (P < .001 for both).

Cumulative 1-year postdischarge health care costs did not significantly differ between the groups (cost ratio = 1.18; 95% CI, 0.91-1.37), according to the researchers.

“We postulate that this lack of statistical significance may be due to our study being underpowered given the wide variation associated with cost data; alternatively, it may be due to the increased mortality in the [permanent pacemaker] group, which reduced the overall follow-up on average for patients with a [permanent pacemaker], and thus cumulative costs,” Aljabbary and colleagues wrote. – by Erik Swain

Disclosure s : Aljabbary reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.