Abstract 12729: Leadless Pacemaker Insertion is Safe in Nonagenarians
Ahmad Harb, Amjad Harb, Abdelraouf Salah, Bilal Al Kalaji, Mariam Khabsa, Amulya Reddy Dwaram, Naim Battikh, Amer Muhyieddeen, Richard Orji, Jashan Gill- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Introduction: Increased age is associated with increased frailty and often worse postoperative outcomes. We aim to assess the safety of leadless pacemaker (LPM) insertion in the very elderly population.
Methods: We queried the National Readmission Database years 2017-2020 for patients who underwent LPM insertion with the ICD10 code 02HK3NZ. Patients with age 90 or more were included in the nonagenarians group. Patient comorbidities were queried through the appropriate ICD 10 codes. We compared outcomes using multivariate logistic and linear regression, adjusting for patient comorbidities.
Results: At baseline, nonagenarians had a higher prevalence of hypertension, history of stroke, A fib./A. flutter, dementia and hypothyroidism. The control group had more of diabetes, coronary disease, chronic kidney disease, chronic pulmonary disease, oxygen use, coagulopathy, anemia, obesity, substance abuse and chronic liver disease (Table 1).
Compared to controls, nonagenarians were found to have shorter length of stay (-2.486 days, p <0.001), lower rate of mortality (aOR 0.696, p 0.0187), lower rates of postprocedural cardiac arrest (aOR 0.301, p 0.0267), mechanical ventilation (aOR 0.378, p <0.001), and vasopressor use (aOR 0.583, p 0.001).
Nonagenarians were only found to have increased risk of pericardial complications (tamponade, pericardiocentesis, hemopericardium) (aOR 1.596, p 0.0151).
There was no significant difference in 30-day readmissions (aOR 0.97, p 0.696), postoperative bleed (aOR 0.84, p 0.072), or stroke (aOR 0.586, p 0.112).
Conclusions: Our study demonstrates LPM insertion is safe in the very elderly population. However this is likely a demonstration of survivorship bias as patients in the nonagenarians group had overall less comorbidities. Even though our analysis adjusted for comorbidities, there are always unknown confounders which cannot be accounted for. Age itself does not seem to be a risk factor for worse outcomes in this population.