The relationship between time to urgent or emergency pacemaker implantation and entry into residential aged care or death in older adults

Q: What are the key findings of this study?

Delayed permanent pacemaker insertion (≥48 hours) was independently associated with a significantly increased risk of death (HR 1.77) over a median 4.5-year follow-up compared to early insertion.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Bradyarrhythmia requiring non-elective inpatient permanent pacemaker insertion (n=375). Intervention: Delayed permanent pacemaker (PPM) insertion (≥48 hours from admission) vs. Early PPM insertion (<48 hours from admission). Primary outcome: Death at follow-up (HR 1.77, 95% CI 1.23-2.54, p=0.002).

Q: What does this research mean for the field?

Delayed permanent pacemaker insertion (≥48 hours from admission) in older adults is independently associated with an increased risk of long-term mortality. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Diane Nguyen; Madeleine Landwehr; Caitlyn Taylor; Eng Sim; Stephen Bacchi; Graham S. Hillis; Leon Flicker; Carl Schultz; Lucy Kilshaw; N. Stoyanov; Jamie W. Bellinge

doi:10.1007/s40520-026-03413-4

June 7, 2026Open Access

The relationship between time to urgent or emergency pacemaker implantation and entry into residential aged care or death in older adults

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Key result

Delayed pacemaker insertion linked to ~77% higher long-term mortality vs. early placement.

HR 1.77
95% CI 1.23-2.54
P=0.002
NNT 8
n=375

Figures

Why the study?

Delays to permanent pacemaker insertion in older adults may be associated with poor health outcomes, but the relationship with mortality and residential aged care admission is unclear.

Does delayed time to permanent pacemaker insertion increase the risk of death or residential aged care admission in older adults requiring urgent or emergent pacing?

Key Points

To investigate whether time from hospital admission to non-elective permanent pacemaker insertion is associated with death or admission to a residential aged care facility in older adults.
Retrospective cohort study of 375 patients aged ≥65 years undergoing non-elective inpatient permanent pacemaker insertion at Royal Perth Hospital between April 2019 and January 2022.
Assessed time from hospital admission to pacemaker insertion (median 47 [22–90] hours) as the exposure against subsequent death or residential aged care facility admission using Cox proportional hazards modelling.
Death occurred in 50.3% (91/181) of patients with delayed insertion (≥48 hours) versus 37.1% (72/194) in the early insertion group; each additional day to insertion was associated with increased mortality in univariate analysis (HR 1.05, 95% CI [1.03–1.07], p < 0.001) and multivariable analysis (HR 1.03 [1.00–1.05], p = 0.027).
Residential aged care facility admission occurred in 19.3% (35/181) of delayed patients compared with 14.9% (29/194) of early patients, showing an association with time to insertion in univariate analysis (HR 1.03 [1.00–1.07], p = 0.049) that did not persist in multivariable modelling (HR 1.00 [0.96–1.04], p = 0.92).

Study Design

Type

Cohort (n=375)

Multicenter

No

Structured PICO

Does delayed time to permanent pacemaker insertion increase the risk of death or residential aged care admission in older adults requiring urgent or emergent pacing?

P

Population

375 older adults (aged ≥65 years, mean 80.8 years) requiring urgent or emergent permanent pacemaker insertion, followed for a median of 1635 days for mortality outcomes.

E

Exposure

Delayed time from hospital admission to permanent pacemaker (PPM) insertion (examined as a continuous variable in days, or dichotomized as ≥48 hours).

C

Comparator

Early permanent pacemaker (PPM) insertion (<48 hours from admission).

O

Outcome

Death at follow-up (median 1635 days) and co-primary endpoint of residential aged care facility (RACF) admission at follow-up (median 1789 days).hard clinical

Main Result

Hazard Ratio: 1.77 (95% CI 1.23–2.54)

Absolute Event Rate: 50.3% vs 37.1%

Absolute Risk Reduction: 13.2%

Number Needed to Treat: 8

p-value: p=0.002

Limitations

Retrospective observational nature precludes the ability to determine a causal relationship.
Potential for residual confounding from unmeasured factors such as frailty and unaccounted illness at time of presentation.
Single-center study with specific procedural availability (weekday and on-call weekend) limits generalisability.
RACF admission was used as a surrogate for functional decline, which may result in misclassification as patients enter RACF for other reasons.
Mortality and RACF placement may be under-reported due to subsequent private hospital admissions or deaths outside the public health system.
Retrospective observational design precludes determining causality
Single-center study may limit generalizability
Residual confounding from unmeasured factors such as frailty or acute illness severity
Possible under-reporting of RACF placement or death outside the public health system
Inability to temporally describe inpatient complications in relation to timing of PPM insertion

Implication

In older adults requiring urgent or emergent permanent pacemaker insertion, a delay of 48 hours or more from admission to procedure is associated with an increased risk of long-term mortality and inpatient complications.

Abstract

BACKGROUND: Older adults often require permanent pacemaker (PPM) insertion. Delays to PPM insertion may associate with poor health outcomes. AIMS: To investigate the association between delayed PPM insertion and adverse outcomes in older adults. METHODS: Patients aged ≥65 years who underwent non-elective inpatient PPM insertion at Royal Perth Hospital between April 2019 and January 2022 were included in this retrospective cohort study. The relationship between time from admission to PPM insertion (exposure) and death or residential aged care facility (RACF) admission was examined using Cox modelling. RESULTS: In 375 patients, with a mean age of 80.8±7.5 years, the median [25th – 75th ] duration from admission to PPM insertion was 47 [22–90] hours. Time from admission to PPM insertion (days) was associated with an increased risk of death at 1635 [1048–1931] days follow-up in univariate regression models (HR 1.05, 95% CI [1.03–1.07], p < 0.001) and after adjusting for comorbidities, demographics, clinical presentation characteristics and number of inpatient complications (HR 1.03 [1.00–1.05], p = 0.027). Time from admission to PPM insertion was associated with an increased risk of RACF admission at 1789 [1546–2128] days follow-up in univariate (HR 1.03 [1.00–1.07], p = 0.049), but not in multivariable regression models (HR 1.00 [0.96–1.04], p = 0.92). DISCUSSION: These findings support the existing literature associating delays to medical intervention and poor health outcomes in older adults. CONCLUSION: In older adults, prolonged time from admission to PPM insertion was associated with higher mortality. Future research is needed to determine if reducing time to PPM insertion may improve their health outcomes. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40520-026-03413-4.

Discussion

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Cite This Study

Nguyen et al. (2026) conducted a cohort in Bradyarrhythmia requiring non-elective inpatient permanent pacemaker insertion (n=375). Delayed permanent pacemaker (PPM) insertion (≥48 hours from admission) vs. Early PPM insertion (<48 hours from admission) was evaluated on Death at follow-up (HR 1.77, 95% CI 1.23-2.54, p=0.002). Delayed permanent pacemaker insertion (≥48 hours) was independently associated with a significantly increased risk of death (HR 1.77) over a median 4.5-year follow-up compared to early insertion.

synapsesocial.com/papers/6ad0fcb515427f6a840402e6 https://doi.org/10.1007/s40520-026-03413-4

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The relationship between time to urgent or emergency pacemaker implantation and entry into residential aged care or death in older adults

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

The relationship between time to urgent or emergency pacemaker implantation and entry into residential aged care or death in older adults

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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