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Pacemakers more common among patients with cognitive impairment
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Cognitive impairment increased the risk of receiving a pacemaker among older patients in a recent retrospective cohort study.
Researchers evaluated results from the National Alzheimer’s Coordinating Center uniform data set, collected from 33 Alzheimer’s disease centers from 2005 to 2011. All participants (n=16,245) underwent at least one baseline and one follow-up visit at a disease center during the evaluated period. Cognitive status was measured according to Clinical Dementia Rating (CDR) scale and diagnosis. Incident pacemaker implantation was determined at each visit.
Participants were without cognitive impairment in 45.8% of cases at baseline, whereas 21.3% had mild impairment and 32.9% had dementia. Incident pacemaker implantation was significantly more common among patients with cognitive impairment during the study, with four implantations per 1,000 person-years among those without impairment; 4.7 per 1,000 person-years among those with mild impairment and 6.5 per 1,000 person-years among those with dementia (P=.001). Researchers noted that implantable cardioverter defibrillator implantation was infrequent among all groups (≤0.5 per 1,000 person-years), which prohibited multivariable analysis.
Patients with dementia were significantly more likely to have a pacemaker than those without cognitive impairment on adjusted analysis (adjusted OR=1.6; 95% CI, 1.1-2.5). Further analysis accounting for cognitive status during consecutive visits indicated a significantly increased risk for incident pacemaker with stable dementia compared with no impairment (adjusted OR=1.8; 95% CI, 1.2-2.8).
Separate analysis according to CDR scale indicated increased risk for pacemaker implantation among those with a score of 3, indicating severe dementia, compared with a score of 0, indicating no impairment (adjusted OR=2.9; 95% CI, 1.2-7.4).
“Participants who had dementia before assessment for a new pacemaker were 1.6 times more likely to receive a pacemaker compared to participants without cognitive impairment, even after clinical factors were taken into account,” researcher Nicole Fowler, PhD, of Indiana University, said in a press release. “This was a bit surprising because aggressive interventions might not be appropriate for this population, whose lives are limited by a severely disabling disease. Future research should explore how doctors, patients and families come to make the decision to get a pacemaker.”
Disclosure: The researchers report no relevant financial disclosures.
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