title: Survival and functional independence after implantation of a permanent pacemaker in octogenarians and nonagenarians. A population-based study.
abstract: BACKGROUND
  The number of very elderly persons who are candidates for implantation of a permanent pacemaker is increasing, but the effect of cardiac pacing on long-term survival and functional variables has not been determined.
  
  
  OBJECTIVE
  To determine long-term survival after implantation of a permanent pacemaker in octogenarians and nonagenarians and to assess functional independence after such implantation.
  
  
  METHODS
  Retrospective, population-based cohort study.
  
  
  METHODS
  Epidemiologic setting from an unselected population.
  
  
  METHODS
  157 octogenarians and nonagenarians who initially received a pacemaker between 1962 and 1988 and were followed through 1992.
  
  
  METHODS
  Overall mortality rate, functional capabilities, and placement in a nursing home.
  
  
  RESULTS
  Observed survival in patients with heart disease was significantly worse than that in age-and sex-matched controls (P < 0.001). Observed survival in community residents without heart disease was similar to that in controls (P > 0.2). Multivariable analysis identified congestive heart failure, chronic obstructive pulmonary disease, old age, syncope, cancer, and atrioventricular block as independent predictors of increased mortality. Symptoms decreased in 118 patients (75%) after pacemaker implantation. After implantation, 70 patients (45%) were permanently placed in nursing homes; this number is similar to the estimated probability of lifetime use of nursing homes from the National Mortality Followback Survey. Dementia developed or worsened in 51 patients (32%), and orthopedic disability occurred in 41 patients (26%).
  
  
  CONCLUSIONS
  Normal relative survival in octogenarians and nonagenarians without heart disease is reassuring; the poor prognosis in patients with heart disease warrants careful evaluation of the methods and indications for cardiac pacing. Permanent pacing alleviates bradycardia-related symptoms. Placement in a nursing home and development or worsening of cardiac, neurologic, or orthopedic disabilities frequently occur after implantation of a permanent pacemaker in the very elderly.
authors.affiliation: Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: W K
authors.initials: WK
authors.lastname: Shen
authors.forename: D L
authors.initials: DL
authors.lastname: Hayes
authors.forename: S C
authors.initials: SC
authors.lastname: Hammill
authors.forename: K R
authors.initials: KR
authors.lastname: Bailey
authors.forename: D J
authors.initials: DJ
authors.lastname: Ballard
authors.forename: B J
authors.initials: BJ
authors.lastname: Gersh
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000401:mortality / Q000628:therapy; D002304:Cardiac Pacing, Artificial; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000401:mortality* / Q000628:therapy*; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009735:Nursing Homes; D016019:Survival Analysis