Social and clinical predictors of 90-day readmission after hospitalization for pacemaker implantation in patients with dementia: insight from the National Readmissions Database

Abstract

Abstract Background Patients with dementia are one of the most common subpopulations that are at risk for readmission and are responsible for a significant burden on American healthcare resources. In addition to this, many studies have shown poor outcomes with dementia patients undergoing invasive procedures. Nonetheless, dementia patients presenting with conditions such as high degree heart block and sinus node dysfunction still require pacemaker implantation (PMI). Purpose We aimed to analyze social and clinical predictors of readmission in those with Dementia who were admitted for PMI. Methods We utilized the National Readmission Database (NRD) from 2018 to identify adults hospitalized for pacemaker implantation (PMI) who also had dementia. We included those who were readmitted within 90 days after the index admission. We excluded elective and traumatic admissions. A multivariate cox regression model was used to identify independent predictors of readmission. Results In our study, 7,529 patients with dementia who were hospitalized for pacemaker implantation (PMI) were discharged alive. Within 90-days from discharge, 1,250 (16.6%) were readmitted. The top three causes of readmission were heart failure (12.2%), sepsis (8%), and acute kidney injury (5%). Readmitted patients had more comorbidities (≥3; 64.4% vs 57.3%; p<0.001), higher rates of intubation (4.9% vs 1.59%; p<0.001) and annual income < $44,000 (29.39% vs 25.7%; p=0.03). In-hospital mortality (3.9% vs 1.27%; p<0.001) was higher during readmission. Figure 1 shows the Forrest plot of multivariate analysis of independent factors associated with readmissions. Conclusion We identified predictors of readmission after hospitalization for PMI in dementia patients such as household income, leaving against medical advice, federal insurance, heart failure, atrial flutter, and liver disease during their index admission. Healthcare systems should use this data to have an open discussion with caregivers and family members to weigh the prognosis on a case by case basis prior to pacemaker implantation in this population.