title: Temporal trends in permanent pacemaker implantation: a population-based study.
abstract: BACKGROUND
  Limited data exist regarding temporal trends in permanent pacemaker (PPM) implantation. To describe trends in incidence and comorbidities of PPM recipients, we conducted a retrospective population-based cohort study over a 30-year period.
  
  
  METHODS
  All 1291 adult residents of Olmsted County, Minnesota, undergoing PPM implantation between 1975 and 2004 were included in the study. Trends in PPM implantation incidence, pacing mode and indication, and comorbidities (via Charlson Comorbidity Index [CCI]) were assessed through the Rochester Epidemiology Project. Permanent pacemaker recipients were compared with age- and sex-matched PPM-free controls from the population.
  
  
  RESULTS
  Adjusted implantation incidence rates increased from 36.6 per 100,000 person-years during 1975 to 1979 to 99 per 100,000 person-years during 2000 to 2004 (P < .0001). After adjusting for age (hazard ratio [HR] 1.06 per year), male sex (HR 1.28), and implant year (HR 0.98), the HR for death among PPM recipients by CCI quartiles was 1.0, 1.79, 2.29, and 3.91 for CCI of 0 to 1 (reference), 2 to 3, 4 to 6, and > or = 7, respectively (P < .0001). Overall, PPM recipients had higher CCI than the population-based controls (P = .04), with higher mean CCI noted since 1990. Mean age-adjusted CCI increased from 3.15 to 4.60 among the cases (P < .0001) and from 3.06 to 3.54 among the age- and sex-matched controls (P = .047).
  
  
  CONCLUSIONS
  There have been significant increases in incidence of PPM implantation over 30 years, and PPM recipients have had an age-independent increase in comorbidities relative to the underlying population, especially over the past 15 years.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA. duslan@mednet.ucla.edu
authors.forename: Daniel Z
authors.initials: DZ
authors.lastname: Uslan
authors.forename: Imad M
authors.initials: IM
authors.lastname: Tleyjeh
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Jenkins
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: St Sauver
authors.forename: David L
authors.initials: DL
authors.lastname: Hayes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial / Q000639:trends*; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors