Abstract 3877: Temporal Trends in Permanent Pacemaker Implantation: A Population-Based Cohort Study
Objective: To describe temporal trends in incidence and comorbidities of permanent pacemaker (PPM) implantation over the past 30 years.
Methods: Using the resources of the Rochester Epidemiology Project, we conducted a population-based cohort study of all adult patients in Olmsted County, MN with PPM implanted between 1975 and 2004. Trends in age, gender, and degree of comorbidity (via Charlson comorbidity index [CCI]) were assessed. To assess whether changes in CCI score were related to changes in population demographics and comorbidities over time, 1146 of the implanted patients were matched by age, gender, and date to referent device-free controls from the population.
Results: 1291 adult patients underwent PPM placement. Ages ranged from 18.5 years to 99.5 years (mean age, 76 years). 53% were female. In comparing incidence rates over 5-year intervals of implant date, rates have increased significantly (LR for age- and gender- adjusted year effect: p<0.0001) from 1975 to 2004. After adjusting for age at implant, mean CCI score increased from 3.15 to 4.60 among the cases (p<0.0001) and from 3.06 to 3.54 among the controls (p=0.047). To assess if trends in CCI score were due to shifting population demographics rather than increasing comorbidities of PPM patients, the CCI scores of cases were compared to the matched referent patients via a multivariate linear regression model including age quartile, year of implantation (quinquennium), and case status. For each 5-year increase, mean CCI score increased by 0.33 (p=0.007).
Conclusions: There have been significant increases in incidence of PPM implantation over 30 years. Compared to the underlying population, the comorbidities of patients undergoing PPM implantation have been increasing as well. This trend may explain increases in rates of device complications, such as infection, that have been described.