Background: Clinical trial data suggest right ventricular pacing may lead to pacemaker-induced cardiomyopathy, increasing risk of heart failure (HF) and death, but that cardiac resynchronization therapy (CRT) may decrease risk among pacemaker patients with heart-failure and an anticipated need for frequent pacing.
Objective: To estimate the prevalence of HF diagnosis and subsequent upgrade to CRT among pacemaker patients using a large contemporaneous real-world population.
Methods: Optum® de-identified Electronic Health Record dataset (2007-2017) and Medtronic device data were linked to examine records of pts (age>18 years) with a pacemaker and atrioventricular (AV) block. The proportion of pacemaker patients with a HF diagnosis prior to implant was analyzed as well as time from implant to HF diagnosis for patients without a prior diagnosis. Finally, time from HF diagnosis to CRT upgrade was analyzed for patients with HF diagnosis occurring after pacemaker implant.
Results: Among 23,377 pacemaker patients with an indication for AV block (median age 76, 55% male), 4,639 (19.8%) had HF diagnosis prior to implant. Among the 18,738 patients without a prior diagnosis, an estimated 31.5% [95% CI: 30.3%, 32.7%] were diagnosed within six years. Among 2,994 patients diagnosed with HF after implant, an estimated 7.2% [95% CI: 6.2%, 8.2%] upgraded to CRT within 24 months of their diagnosis.
Conclusion: In a large, contemporaneous sample of pacemaker patients with AV block, HF diagnosis is common, with over half of patients receiving at least one diagnosis either prior to implant or within six years after. However, CRT upgrade remains relatively uncommon among these patients.