Date of Award

January 2012

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Rachel Lampert

Subject Area(s)

Medicine

Abstract

Data are scarce on outcomes of pacemaker (PM) implantation in the very elderly, limiting the ability to make informed decisions. We used national data to assess the hypothesis that increasing age is associated with significantly worse procedural outcomes (in-hospital mortality and complications). Patients ≥ 70 years with a new PM implant were identified in the 2004-2008 HCUP-Nationwide Inpatient Sample. Patient demographic and clinical variables as well as hospital characteristics were analyzed. Clinical outcomes were compared using χ², Mantel-Haenszel tests, and multivariate hierarchical logistic models. We identified 115,683 patients (mean age 81.47 years; SEM 0.02), of which 45,507 (39.3%) were 70-79 years old, 57,259 (49.5%) were 80-89, and 12,917 (11.2%) were ≥ 90. Unadjusted mortality and complication rates respectively were 0.60% and 5.61% in age group 70-79, 0.99% and 6.13% in age 80-89, and 1.87% and 6.31% in age ≥ 90, p<0.001. Multivariable analysis revealed severe comorbidity (OR 5.00; 95% CI 4.05-6.17) and nonelective admission (OR 3.09; CI 2.46-3.88) were greater predictors of mortality than increasing age (OR 2.81; CI 2.35-3.35), all p<0.0001. For complications, severe comorbidity (Charlson score ≥ 5) (OR 1.35; CI 1.20-1.51) and female gender (OR 1.35; CI 1.28-1.42) were larger predictors than increasing age (OR 1.07; CI 1.01-1.13), all p<0.02. Although increasing age is a predictor of worsening outcomes in the elderly, the absolute rates are modest, even in nonagenarians, and other factors are more important predictors than age.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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