Older patients with severe dementia 2.9 times more likely to receive pacemaker

A team of researchers reviewing decisions to implant cardiac devices found that older patients with cognitive impairment were more often implanted with pacemakers, according to a study published online July 28 in JAMA Internal Medicine.

The study utilized data from the National Alzheimer Coordinating Center Uniform Data set from September 2005 through December 2011. Of the 16,245 older participants, 45.8 percent had no cognitive impairment, 21.3 percent had mild cognitive impairment and 32.9 percent had dementia at baseline.

Nicole R. Fowler, MD, MHSA, of the University of Pittsburgh, and colleagues found that over the course of the study period, the greater the cognitive impairment, the more likely a patient was to have a pacemaker or implantable cardioverter-defibrillator (ICD). Patients with mild cognitive impairment were 1.6 times more likely to receive a pacemaker than those without cognitive impairment. Patients with stable dementia were 1.8 times more likely to receive a pacemaker than those without. When assessed for severity, patients with a clinical dementia rating of 3, implying severe dementia, were 2.9 times as likely to receive a pacemaker than those who without cognitive impairment.

Fowler et al have not assessed why these patients were more likely to receive surgical intervention over less impaired counterparts. While future work would lend itself to that line of question, Fowler et al also recommended careful consideration of risks and benefits to the patient, their quality and quantity of life and careful physician discussions with patients and their caregivers about decision-making for cardiac devices in this vulnerable population.