Demographics, Morbidity and Mortality Outcomes of Cardiac Implantable Electronic Devices (CIED)

Abstract

Background

Cardiac implantable electronic device (CIED) utilisation has steadily increased. This has been driven by advancing technology, updated guidelines affirming indications for implantations and the ageing population. However, the usage of CIED in the real world is unclear.

Aims

The aim of this thesis was to identify the epidemiology of CIED implantation and outcomes post implantation in an unselected statewide population by utilising data from a large database of patients in New South Wales (NSW) presenting for CIED implantation between 2009 – 2018. The main aims of this thesis were to investigate: 1) Trends of permanent pacemaker implantation (PPI) and sex disparities in rates of PPI in NSW; 2) Outcomes following implantable cardioverter-defibrillator (ICD) insertion in patients ≥80 years old.

Results

The first part of the thesis examined the sex differences in the rates of PPI and in-hospital complications. 28,714 PPI were included. Women comprised 40% of the study population. The total in-hospital complications were higher in women compared to men. After adjusting for multiple covariates, female sex remained an independent predictor of increased complications post PPI. The second part of the thesis examined the impact of elderly age on morbidity and mortality post ICD implantation in 9,304 patients. The in-hospital mortality was 0.4% and did not vary between age groups. However, 1-year mortality was 2.1%, 5.9% and 10.7% in <60yo, 60-79yo and ≥80yo respectively (P<0.001). In the subgroup of patients aged ≥80yo (n=1127), age was an independent predictor of 1-year mortality (median age >83yo: hazard ratio 1.72, 95% CI 1.19-2.48, P=0.004).

Conclusions

There is persistent sex disparity in PPI rates and future studies should be undertaken to find the reasons for this. Age ≥83yo in the subgroup analysis was an independent adverse predictor for 1-year mortality. Age and co-morbidities should be considered in assessing the appropriateness of ICD in patients ≥80yo.