Open AccessMultimorbidity, polypharmacy, and mortality in older patients with pacemakers
Author(s) -
Goto Toshihiko,
Mori Kento,
Nakayama Takafumi,
Yamamoto Junki,
Shintani Yasuhiro,
Wakami Kazuaki,
Fukuta Hidekatsu,
Seo Yoshihiro,
Ohte Nobuyuki
Publication year - 2022
Publication title -
journal of arrhythmia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.463
H-Index - 21
eISSN - 1883-2148
pISSN - 1880-4276
DOI - 10.1002/joa3.12660
Subject(s) - polypharmacy , medicine , comorbidity , charlson comorbidity index , hazard ratio , confidence interval , multimorbidity , pediatrics , emergency medicine
Background The prevalence of multimorbidity and polypharmacy and its association with all‐cause mortality in older patients with pacemakers are largely unknown. We aimed to clarify the prevalence of multimorbidity and polypharmacy, and its association with all‐cause mortality in patients ≥75 years of age with pacemakers. Methods We retrospectively investigated 256 patients aged ≥75 years (mean age 84.0 ± 5.3 years; 45.7% male) with newly implanted pacemakers. The study endpoint was all‐cause mortality (“with events”). Multimorbidity was defined as a Charlson Comorbidity Index ≥3. Polypharmacy was defined as the use of ≥5 medications. Results During the follow‐up period (median, 3.1 years), 60 all‐cause deaths were reported. The Charlson Comorbidity Index (2.9 ± 1.9 vs. 1.7 ± 1.7, p < .001) and prevalence of multimorbidity (56.7% vs. 26.0%, p < .001) were significantly higher in deceased patients than in survivors. The number of drugs (6.9 ± 3.0 vs. 5.9 ± 3.3, p = .03) and the prevalence of polypharmacy (78.3% vs. 63.8%, p = .04) were significantly higher in patients with events than in those without events. The event‐free survival rate was significantly higher among patients without multimorbidity than in those with multimorbidity (log‐rank, p < .001), and was also significantly higher among patients without polypharmacy than in those with polypharmacy (log‐rank, p < .001). Multimorbidity (hazard ratio [HR]: 3.21; 95% confidence interval [CI]: 1.85–5.58; p < .001) and polypharmacy (HR: 1.97; 95% CI: 1.03–3.77; p = .04) were independent predictors of all‐cause mortality. Conclusions Multimorbidity and its associated polypharmacy, which are common in the older population, are prevalent in patients with pacemakers and are independent predictors of poor prognosis.