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Predictors of long-term survival prior to permanent pacemaker implantation in octogenarians or older

BACKGROUND: There is an increased need for permanent pacemaker (PPM) implantation for older patients with multiple comorbidities. The current guidelines recommend that, before implanting PPM, clinicians should discuss life expectancy with patients and their families as part of the decision-making pr...

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Autores principales: Cheng, Chi-Wen, Wang, Chao-Hung, Chen, Wei-Siang, Wang, Chun-Chieh, Cherng, Wen-Jin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6589145/
https://www.ncbi.nlm.nih.gov/pubmed/30259339
http://dx.doi.org/10.1007/s40520-018-1044-4
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author Cheng, Chi-Wen
Wang, Chao-Hung
Chen, Wei-Siang
Wang, Chun-Chieh
Cherng, Wen-Jin
author_facet Cheng, Chi-Wen
Wang, Chao-Hung
Chen, Wei-Siang
Wang, Chun-Chieh
Cherng, Wen-Jin
author_sort Cheng, Chi-Wen
collection PubMed
description BACKGROUND: There is an increased need for permanent pacemaker (PPM) implantation for older patients with multiple comorbidities. The current guidelines recommend that, before implanting PPM, clinicians should discuss life expectancy with patients and their families as part of the decision-making process. However, estimating individual life expectancy is always a challenge. AIMS: We investigated predictors of long-term survival prior to PPM implantation in patients aged 80 or older. METHODS AND RESULTS: From September 2004 to September 2015, 100 patients aged ≥ 80 years who received PPM implantation were included for retrospective survival analysis. The end point was all-cause mortality. Follow-up duration was 4.0 ± 2.7 years. By the end of the study, 54 patients (54%) had died. Of the 54 who died, 40 patients (74.1%) died of non-cardiac causes. Their survival rates at 1, 2, 3, 5, and 7 years were 90%, 76%, 54%, 32%, and 16%, respectively. Patients with a longer length of hospital stay before PPM implantation (LOS-B) [hazard ratio (HR) 1.03, 95% confidence interval (CI) 1.02–1.05, p < 0.001], estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73 m(2) (HR 4.07, 95% CI 1.95–8.52, p < 0.001), body mass index (BMI) < 21 kg/m(2) (HR 2.50, 95% CI 1.16–5.39, p = 0.02), and dyspnea as the major presenting symptom (HR 2.88, 95% CI 1.27–6.55, p = 0.01) were associated with lower cumulative survival. CONCLUSIONS: Longer LOS-B, lower eGFR and BMI, and dyspnea as the major presenting symptom are pre-PPM implantation predictors of long-term survival in patients aged 80 or older.
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spelling pubmed-65891452019-07-05 Predictors of long-term survival prior to permanent pacemaker implantation in octogenarians or older Cheng, Chi-Wen Wang, Chao-Hung Chen, Wei-Siang Wang, Chun-Chieh Cherng, Wen-Jin Aging Clin Exp Res Original Article BACKGROUND: There is an increased need for permanent pacemaker (PPM) implantation for older patients with multiple comorbidities. The current guidelines recommend that, before implanting PPM, clinicians should discuss life expectancy with patients and their families as part of the decision-making process. However, estimating individual life expectancy is always a challenge. AIMS: We investigated predictors of long-term survival prior to PPM implantation in patients aged 80 or older. METHODS AND RESULTS: From September 2004 to September 2015, 100 patients aged ≥ 80 years who received PPM implantation were included for retrospective survival analysis. The end point was all-cause mortality. Follow-up duration was 4.0 ± 2.7 years. By the end of the study, 54 patients (54%) had died. Of the 54 who died, 40 patients (74.1%) died of non-cardiac causes. Their survival rates at 1, 2, 3, 5, and 7 years were 90%, 76%, 54%, 32%, and 16%, respectively. Patients with a longer length of hospital stay before PPM implantation (LOS-B) [hazard ratio (HR) 1.03, 95% confidence interval (CI) 1.02–1.05, p < 0.001], estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73 m(2) (HR 4.07, 95% CI 1.95–8.52, p < 0.001), body mass index (BMI) < 21 kg/m(2) (HR 2.50, 95% CI 1.16–5.39, p = 0.02), and dyspnea as the major presenting symptom (HR 2.88, 95% CI 1.27–6.55, p = 0.01) were associated with lower cumulative survival. CONCLUSIONS: Longer LOS-B, lower eGFR and BMI, and dyspnea as the major presenting symptom are pre-PPM implantation predictors of long-term survival in patients aged 80 or older. Springer International Publishing 2018-09-27 2019 /pmc/articles/PMC6589145/ /pubmed/30259339 http://dx.doi.org/10.1007/s40520-018-1044-4 Text en © The Author(s) 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Article
Cheng, Chi-Wen
Wang, Chao-Hung
Chen, Wei-Siang
Wang, Chun-Chieh
Cherng, Wen-Jin
Predictors of long-term survival prior to permanent pacemaker implantation in octogenarians or older
title Predictors of long-term survival prior to permanent pacemaker implantation in octogenarians or older
title_full Predictors of long-term survival prior to permanent pacemaker implantation in octogenarians or older
title_fullStr Predictors of long-term survival prior to permanent pacemaker implantation in octogenarians or older
title_full_unstemmed Predictors of long-term survival prior to permanent pacemaker implantation in octogenarians or older
title_short Predictors of long-term survival prior to permanent pacemaker implantation in octogenarians or older
title_sort predictors of long-term survival prior to permanent pacemaker implantation in octogenarians or older
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6589145/
https://www.ncbi.nlm.nih.gov/pubmed/30259339
http://dx.doi.org/10.1007/s40520-018-1044-4
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