The relationship between time to urgent or emergency pacemaker implantation and entry into residential aged care or death in older adults

Background

Older adults often require permanent pacemaker (PPM) insertion. Delays to PPM insertion may associate with poor health outcomes.

Aims

To investigate the association between delayed PPM insertion and adverse outcomes in older adults.

Methods

Patients aged ≥65 years who underwent non-elective inpatient PPM insertion at Royal Perth Hospital between April 2019 and January 2022 were included in this retrospective cohort study. The relationship between time from admission to PPM insertion (exposure) and death or residential aged care facility (RACF) admission was examined using Cox modelling.

Results

In 375 patients, with a mean age of 80.8±7.5 years, the median [25th – 75th ] duration from admission to PPM insertion was 47 [22–90] hours. Time from admission to PPM insertion (days) was associated with an increased risk of death at 1635 [1048–1931] days follow-up in univariate regression models (HR 1.05, 95% CI [1.03–1.07], p < 0.001) and after adjusting for comorbidities, demographics, clinical presentation characteristics and number of inpatient complications (HR 1.03 [1.00–1.05], p = 0.027). Time from admission to PPM insertion was associated with an increased risk of RACF admission at 1789 [1546–2128] days follow-up in univariate (HR 1.03 [1.00–1.07], p = 0.049), but not in multivariable regression models (HR 1.00 [0.96–1.04], p = 0.92).

Discussion

These findings support the existing literature associating delays to medical intervention and poor health outcomes in older adults.

Conclusion

In older adults, prolonged time from admission to PPM insertion was associated with higher mortality. Future research is needed to determine if reducing time to PPM insertion may improve their health outcomes.