Life expectancy after implantation of a first cardiac permanent pacemaker (1995-2008): A population-based study.
BACKGROUND
Research suggests that survival among the recipients of a cardiac permanent pacemaker (PPM) matches the age- and sex-matched general population in the absence of cardiovascular disease. We used linked administrative data to examine life expectancy-based outcomes for adults requiring a cardiac PPM.


METHODS
Population-level hospital admissions data were used to identify all recipients of an initial PPM during 1995-2008. Expected years of additional life remaining at the time of implantation were calculated for each patient from population life tables. Observed years were calculated using linked mortality data to end 2011. Cox regression was used to determine demographic and clinical predictors of survival.


RESULTS
In 8757 patients age-adjusted risk of death to 5 years was associated with male sex, higher Charlson Comorbidity Index score (excluding cardiac disease), a history of heart failure, cardiomyopathy or atrial fibrillation and emergency admission. Coronary revascularisation surgery reduced long-term risk. The observed/expected ratio of additional years of life was 0.80 for men and 0.84 for women overall, varying from 0.92 for women without significant comorbidity to 0.40 for patients with the highest Charlson score and cardiomyopathy. The oldest patients (80-99 years) did relatively well, probably reflecting patient selection. Heart disease was the most frequent cause of death.


CONCLUSIONS
Life expectancy among PPM recipients without significant comorbidity approached that of the general population. Greater non-cardiac comorbidity, heart failure, atrial fibrillation and, in particular, cardiomyopathy, contributed most to the loss of expected years of life in all age groups. The oldest patients and women did relatively well.
School of Population Health, The University of Western Australia, Australia. Electronic address: pamela.bradshaw@uwa.edu.au.
Pamela J
PJ
Bradshaw
Department of Cardiovascular Medicine, Sir Charles Gairdner Hospital, Australia.
Paul
P
Stobie
School of Population Health, The University of Western Australia, Australia.
Matthew W
MW
Knuiman
School of Population Health, The University of Western Australia, Australia.
Thomas G
TG
Briffa
School of Population Health, The University of Western Australia, Australia.
Michael S T
MS
Hobbs
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial / Q000401:mortality* / Q000639:trends*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008017:Life Expectancy / Q000639:trends*; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000639:trends*; D010343:Patient Admission / Q000639:trends; D011159:Population Surveillance; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
Cardiac pacemaker; Comorbidity; Life expectancy; Survival