Death in patients with permanent pacemakers for sick sinus syndrome.
BACKGROUND
Although more than one million patients in the United States have permanent pacemakers, little is known about their cause of death. We evaluated the cause of death in 404 patients who died in the Mode Selection Trial (MOST).


METHODS
In MOST, patients received a dual-chamber pacemaker randomly programmed to either dual-chamber or ventricular pacing. The circumstances surrounding each death were reviewed by a clinical events committee, which used prospectively defined criteria to adjudicate the cause of death.


RESULTS
A total of 2010 patients with a median age of 74 years were included. After a median follow-up of 33 months, 404 (20%) patients died, including 198 (49%) of noncardiac causes and 143 (35.4%) of cardiac causes. In 63 patients, the cause of death was unknown. Independent predictors of death through the use of a multivariable analysis were (1) demographic factors including age, male sex, and weight; (2) clinical factors including prior myocardial infarction, cardiomyopathy, New York Heart Association class III/IV, and the Charlson Comorbidity Index; and (3) scores from two measures of functional status, the Karnofsky Score and the Mini-Mental State Examination. Independent predictors of cardiovascular death were similar.


CONCLUSIONS
Patients treated with permanent pacemakers for sinus node dysfunction are elderly and have a substantial mortality rate, with more than half the classifiable deaths being noncardiac. Baseline demographic variables and scores from quality-of-life measures can identify patients with the highest risk of death.
Flaker
Greg
G
Division of Cardiology, University of Missouri, Columbia, Columbia, Mo 65212, USA. flakerg@health.missouri.edu
Greenspon
Arnold
A
Tardiff
Barbara
B
Schron
Eleanor
E
Goldman
Lee
L
Hellkamp
Anne
A
Lee
Kerry
K
Lamas
Gervasio
G
D017677:Age Distribution; D000368:Aged; D002318:Cardiovascular Diseases / Q000145:classification / Q000401:mortality*; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D019736:Prostheses and Implants / Q000706:statistics & numerical data*; D011788:Quality of Life; D018570:Risk Assessment; D017678:Sex Distribution; D012804:Sick Sinus Syndrome / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate