Risk Factors and Costs Associated With 1‐Year Mortality and Readmission After Leadless Pacemaker Implantation

Background Leadless pacemakers (LPM) have been shown to be safe and effective alternatives to transvenous pacing systems. Few studies have evaluated the incidence and associated costs of post‐implant complications. The objectives of this study were to assess risk factors and causes for 1‐year mortality and all‐cause readmission, as well as characterize the total cost of care associated with index procedures and readmissions. Methods LPM procedures, including inpatient and outpatient encounters, were captured in the Healthcare Cost and Utilization Project data in Florida, Maryland, and New York from 2016 to 2020 with 1‐year follow‐up through 2021. Cox proportional hazards regression was used to identify patient demographics, facility volume, and comorbid risk factors for 1‐year all‐cause readmission and in‐hospital mortality. Costs of inpatient cases and readmission were captured. Methods Among 7127 patients receiving LPM, 3% died during the initial episode of care. The 1‐year all‐cause readmission rate was 45.9%, and the in‐hospital mortality rate was 8.8%. Comorbid heart failure (CHF), atrial fibrillation/flutter, chronic kidney disease, and diabetes increased the risk of 1‐year all‐cause readmission and in‐hospital mortality ( p < 0.05). CHF was the most common cause of readmission (17%). Inpatient cases resulted in a cost of $257 million, with readmissions increasing costs by 44.4%. Conclusions The large healthcare expenditure derives from high rates of readmission and in‐hospital mortality, with readmissions potentially representing a modifiable target. CHF is a prominent cause of poor outcomes, which suggests the need to consider the overlapping roles of conduction system pacing, goal‐directed medical therapy, and close clinical follow‐up.