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This is a Quantitative Study study.

October 2, 2025Open Access

Independent Predictors of Receiving Pacemaker with Trends of Complications and Mortality in the United States with Higher Prevalence in Male and Caucasians

MMMohammad Reza MovahedUniversity of Arizona NSNandini SodhiUniversity of Arizona MHMehrtash HashemzadehUniversity of Arizona

Key Points

The study identifies various clinical predictors for pacemaker insertion, including atrial fibrillation and hypertension.
Complications from pacemaker insertion were around 2%, while mortality was reported at 1.44% across the evaluated cohort.
The Nationwide Inpatient Sample database revealed a significant prevalence of pacemaker insertion among males and Caucasians.
Findings highlight the importance of understanding risk factors and trends associated with pacemaker use in the United States.

Abstract

Introduction: Risk factors for needing a pacemaker have not been well studied. The goal of this study was to evaluate predictors, complications, trends, and mortality rates of pacemakers in adults. Methods: We utilized the International Classification of Diseases, Tenth Revision, and Clinical Modification coding for this study. We evaluated clinical predictors of pacemaker insertions, their complications, and mortality using the Nationwide Inpatient Sample database for the years 2016–2020 in adults. Results: A total of 647,435 patients had a pacemaker insertion at an average age of 76 years old (±11.48 years). Significant independent clinical predictors for pacer insertion were non-ST-elevation myocardial infarction: 4.3% versus 2.4%, odds ratio (OR), 1.85; 95% confidence interval (CI), 1.80–1.91; P < 0.001, hypertension: 84.40% versus 55.95%, OR, 4.26; 95% CI, 4.19–4.34; P < 0.001, hyperlipidemia: 59.59% versus 2.85%, OR, 3.01; 95% CI, 2.97–3.05; P < 0.001, atrial fibrillation/flutter: 45.89% versus 15.35%, OR, 4.68 95% CI, 4.62–4.74; P < 0.001, diabetes: 35.76% versus 27.20%, OR, 1.49; 95% CI, 1.47–1.51; P < 0.001, chronic kidney disease: 30.00% versus 17.70%, OR, 1.99; 95% CI, 1.97–2.02; P < 0.001, smoking: 29.81% versus 23.10%, OR, 1.41; 95% CI, 1.31–1.43; P < 0.001, chronic obstructive pulmonary disease: 17.63% versus 16.17%, OR, 1.11; 95% CI, 1.09–1.13; P < 0.001, valvular heart disease: 17.19% versus 3.76%, OR, 5.31; 95% CI, 5.21–5.41; P < 0.001, systolic heart failure: 12.94% versus 6.99%, OR, 1.98; 95% CI, 1.94–2.02; P < 0.001, prior percutaneous intervention: 11.70% versus 5.45%, OR, 2.30; 95% CI, 2.26–2.34; P < 0.001, obesity: 10.05% versus 8.57%, 1.19; 95% CI, 1.17–1.22; P < 0.001, history of coronary artery bypass grafting: 10.05% versus 4.32%, OR, 2.48; 95% CI, 2.43–2.52; P < 0.001, STEMI: 1.45% versus 2.66%, 1.45% OR, 1.86; 95% CI, 1.79–1.93; P < 0.001, history of cardiomyopathy: 0.74% versus 0.39%, OR, 1.90; 95% CI, 1.78–2.03; P < 0.001, and endocarditis: 0.15% versus 0.09%, OR, 1.77; 95% CI, 1.53–2.04; P < 0.001. Pacemaker complication rates were around 2% with a mortality of 1.44%. Conclusion: We found many predictors for the need for pacemaker insertion. Mortality and complications have remained low over recent years with higher prevalence in males and Caucasians.

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