96 Clinical frailty and co-morbidities affect outcomes in bradyarrhythmia related device implantation

• Published in: Heart (British Cardiac Society) Vol. 109; no. Suppl 3; pp. A107 - A108
• Main Authors: Warraich, Mazhar, Sunni, Nadia, Ayyaz, Dawar, Haggag, Ahmed
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 02.06.2023; BMJ Publishing Group LTD
• Subjects: Bradyarrhythmia; Cardiac arrhythmia; Cardiac Rhythm Management; Cardiovascular disease; Frailty; Heart failure; Kidney diseases; Mortality; Pacemaker; Transplants & implants
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2023-BCS.96

Background and AimsAge, heart disease, peripheral vascular disease, pulmonary disease and renal disease affect mortality in implantable cardiac defibrillators.1 We aim to examine how frailty and co-morbidities impact mortality in patients receiving simple bradyarrhythmia cardiac pacing device implants in a district general hospital.MethodsA total pf 700 consecutive novel standard bradyarrhythmia cardiac device were implanted between 01/01/2016 to 28/02/2021. Patient frailty was calculated with Rockwood Frailty Score2,3 (RFS) and comorbidities at the time of implant recorded through the electronic patient record. Follow up until allowed at least a 2-year follow-up for all surviving patients. Results were analysed with Kaplan-Meier survival curves and Hazard Ratios (HR) and Risk Ratios (RR).ResultsMean age of implant was 78.4±10.3 in 272/700 (38.8%) female group. The mortality rate was 87/700 (12.4%) at one year rising to total 282/700 (40.3%) at follow-up. Overall, mild or greater frailty defined as RFS score of 5 or more was associated with death overall HR 2.05 (95% CI 1.61-2.60) and 3.42 (95% CI 2.23-5.24) within 1 year (Fig. 1).We found heart failure (OR 2.38, 95% CI 1.59-3.57), valvular heart disease (OR 3.19, 95% CI 2.08-4.89), atrial fibrillation/flutter (OR 1.44, 95% CI 1.09-1.91), chronic kidney disease (OR 1.89, 95% CI 1.296-1.72), malignancy (OR 1.91, 95% CI 1.08-3.36) were associated with death within one year of implant. Whilst ischemic heart disease and cognitive impairment including dementia demonstrated a tendency towards worse mortality but did not reach significance (Fig. 2).ConclusionMultiple comorbidities including heart failure, valvular heart disease, atrial fibrillation, chronic kidney disease and malignancy and frailty are associated with death within 1 year after novel implant of bradyarrhythmia cardiac pacing device implants. Greater consideration should be given to advanced frailty and multimorbid states during the shared decision making and consent process in multidisciplinary team discussion.Abstract 96 Figure 1Risk Ratio for death within 12 months after bradycardia device implantation by co-morbidityAbstract 96 Figure 2Kaplan-Meier survival curve for high compared to low Rockwood frailty score in bradycardia pacing device implantsConflict of InterestNil