Background
Infective endocarditis (IE) remains a serious complication after transvenous permanent pacemaker (PM) implantation. While geriatric conditions such as dementia, frailty, and cachexia are increasingly recognized as markers of adverse outcomes in cardiovascular medicine, their association with post-implantation endocarditis remains insufficiently investigated.
Methods
We performed a retrospective longitudinal analysis using nationwide insurance claims data including more than 100,000 patients over a 5-year observation period. We excluded patients with prior pacemaker implantation. The occurrence of IE after PM implantation was assessed based on ICD coding within yearly follow-up intervals. Multivariate cox proportional hazards analyses were performed to identify independent predictors of post-implantation endocarditis.
Results
Among 7,195 eligible patients undergoing first-time PM implantation, 1,996 patients were coded as having IE during follow-up. Of those, 871 (43.6 %) were either demented, frail, or cachectic. Dementia and frailty were significant predictors for IE after PM implantation in univariate Cox regression analyses, whereas cachexia only showed borderline significance. In multivariate analyses, the composite presence of at least one of the three conditions (dementia, frailty, or cachexia) remained independently associated with increased risk of IE following PM implantation.
Conclusions
The geriatric conditions dementia, frailty, and cachexia may identify patients at increased risk for IE following PM implantation. These findings may support individualized device selection strategies, including consideration of leadless pacing systems in vulnerable populations.
