Permanent Pacemaker After TAVR Increases Mortality, Readmission Risks

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Patients who required a permanent pacemaker after TAVR had an increased risk for hospital admissions related to heart failure.
Patients who required a permanent pacemaker after TAVR had an increased risk for hospital admissions related to heart failure.

The insertion of a permanent pacemaker following transcatheter aortic valve replacement (TAVR) was associated with increased long-term morbidity and mortality, according to a study published in JAMA Network Open.

Investigators retrospectively analyzed outcomes of patients who underwent TAVR (N=1263; mean age, 82.3 years). A total of 186 patients received a permanent pacemaker during the index hospitalization following the AVR procedure.

The primary outcomes and measures of this analysis included all-cause mortality, hospital readmission, hospital readmission for heart failure, emergency department visits, and cumulative 1-year healthcare costs.

During the mean follow-up period of 990 days, the investigators observed a significantly higher rate of all-cause mortality in individuals requiring a permanent pacemaker (43.9% vs 31.7%; hazard ratio [HR], 1.40; 95% CI, 1.01-1.94; P =.04).

Additionally, patients who received a pacemaker during the index hospitalization had significantly higher rates of all-cause hospital readmissions (80.9% vs 70.6%; HR, 1.28; 95% CI, 1.15-1.43; P <.001), visits to the emergency department (95.5% vs 87.3%; HR, 1.28; 95% CI, 1.08-1.52; P =.004), and readmissions for heart failure (33.9% vs 19.1%; HR, 1.90; 95% CI, 1.53-2.36; P <.001) compared with patients who did not require the device. No significant effects of the device were observed on 1-year healthcare costs following hospital discharge.

The study's retrospective and observational nature may have limited the findings to associations only. Additionally, in approximately 40% of patients, data on left ventricular ejection fraction were missing, which may have played a role in outcomes.

Considering, as the investigators stated, that “permanent pacemaker implantation after transcatheter aortic valve replacement is a complication associated with worse survival as well as increased risk of hospitalization,” the need for this device may predict risk for mortality and readmission in these patients.

Reference

Aljabbary T, Qiu F, Masih S, et al. Association of clinical and economic outcomes with permanent pacemaker implantation after transcatheter aortic valve replacement. JAMA Network Open. 2018;1(1):e180088.

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