Abstract
BackgroundThis study evaluated the use of comprehensive geriatric assessment (CGA) in older patients undergoing pacemaker implantation.MethodsIn this prospective cohort, CGA was performed in 197 patients ≥75 years at pacemaker implantation and yearly thereafter. CGA embraced the following domains: cognition, mobility, nutrition, activities of daily living (ADLs), and falls (with or without loss of consciousness). Based on comorbidities, the Charlson comorbidity index (CCI) was calculated. For predictive analysis, logistic regression was used.ResultsDuring a mean follow-up duration of 2.4 years, the incidence rates of syncope decreased from 0.46 to 0.04 events per year (p < 0.001), and that of falls without loss of consciousness from 0.27 to 0.15 (p < 0.001) before vs. after implantation. Sixty-three patients (32.0%) died. Impaired mobility (OR 2.60, 95%CI 1.22–5.54, p = 0.013), malnutrition (OR 3.26, 95%CI 1.52–7.01, p = 0.002), and a higher CCI (OR per point increase 1.25, 95%CI 1.04–1.50, p = 0.019) at baseline were significant predictors of mortality. Among 169 patients who survived for more than 1 year and thus underwent follow-up CGA, CGA domains did not deteriorate during follow-up, except for ADLs. This decline in ADLs during follow-up was the strongest predictor of later nursing home admission (OR 9.29, 95%CI 1.82–47.49, p = 0.007). Higher baseline age (OR per year increase 1.10, 95%CI 1.02–1.20, p = 0.018) and a higher baseline CCI (OR per point increase 1.32, 95%CI 1.05–1.65, p = 0.017) were associated with a decline in ADLs during follow-up.ConclusionsCGA is useful to detect functional deficits, which are associated with mortality or nursing home admission after pacemaker implantation. The present study seems to support the use of CGA in older patients undergoing pacemaker implantation as functional deficits and falls are amenable to geriatric interventions.
Highlights
This study evaluated the use of comprehensive geriatric assessment (CGA) in older patients undergoing pacemaker implantation
Thirty-seven patients (18.8%) have suffered from severe injuries associated with the syncopal event or fall
The decline in Activities of daily living (ADLs) from baseline to follow-up was found to be the strongest predictor of later nursing home admission, whereas the baseline variables in the model were not predictive of the outcome
Summary
Study population Consecutive patients ≥75 years of age undergoing pacemaker implantation and being followed at the Heart Center Lucerne (Lucerne, Switzerland) between March 1st, 2012, and March 31st, 2017, were eligible for this prospective cohort study. The final study population consisted of all patients in whom pacemaker implantation and baseline examination were performed during the study period. CGA assessed the number of falls without loss of consciousness and/or syncopes since the baseline examination or the last follow-up, respectively. We descriptively analyzed the change of functional status between baseline evaluation and last available follow-up examination among patients who survived for more than 1 year after pacemaker implantation and had at least one follow-up CGA. We separately analyzed the functional course among surviving patients, who showed a baseline impairment in the respective domain The rational for this analysis was the high clinical relevance of this subgroup; due to the ceiling effect of the assessment instruments, improvements could only be shown for this subgroup. Data were analyzed using Stata 12.1 (StataCorp LP, College Station, TX, USA)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
