Elsevier

American Heart Journal

Volume 156, Issue 3, September 2008, Pages 491-497
American Heart Journal

Clinical Investigation
Outcomes, Health Policy, and Managed Care
Predictors of improved quality of life 1 year after pacemaker implantation

https://doi.org/10.1016/j.ahj.2008.04.029Get rights and content

Background

Patient's health-related quality of life (HRQoL) of pacemaker (PM) patients has increasingly become an important issue of health care evaluation. Currently, knowledge of pacing performance and technology is more or less outlined. However, determinants of poor or good HRQoL of paced patients require further elucidation.

Objectives

The purpose of this study is to determine the HRQoL 1 year after PM implantation and predictors of differences in HRQoL between pre- and post-PM implantation.

Methods

We quantified the mean differences between HRQoL before implantation (baseline) and 1 year later, assessed with the generic Medical Outcomes Survey 36-Item Short-Form Survey and EuroQol (EQ5D), and the PM patient-specific AQUAREL (Assessment of QUality of life And RELated events) questionnaires, in 501 consecutively included patients in the Dutch multicenter longitudinal FOLLOWPACE cohort study. Multivariable linear regression modeling was then performed to determine predictive factors of the HRQoL 1 year after implantation.

Results

The HRQoL of the patients increased markedly in the first year after implantation. Seventy percent of the patients considered their health improved, whereas 11% experienced a complete recovery in HRQoL. The most important predictors for improved HRQoL after 1 year were HRQoL at baseline, age, presence of cardiac comorbidities, and atrial fibrillation with slow ventricular response as indication for chronic pacing.

Conclusion

In most patients receiving a PM, HRQoL increased in the first year after PM implantation. Knowledge of the predictors of this increase may aid physicians to timely differentiate between patients who most likely will benefit most from PM implantation in terms of HRQoL.

Section snippets

Patients

The FOLLOWPACE study was conducted in 24 PM implanting centers in the Netherlands. The design and aims of this study have been published previously.9 FOLLOWPACE is a prospective, observational, prognostic cohort study with the following objectives: First, quantification of inhospital events during and after first PM implantation and events in the follow-up period. Second, the determination of HRQoL before the first PM implantation and during follow-up. Third, to assess which patient information

Results

The mean age of the study population was 73 years, and 58% were males (Table I). Cardiac comorbidity was present in most of the patients.

The mean difference in HRQoL according to the different questionnaires are depicted in Table II. All questionnaire subscales showed a significant improvement except for the SF-36 subscale “General Health.” The SF-36 subscales “Role limitation due to Physical functioning” and “Change in Health” and the Aquarel subscale “Arrhythmias” showed a moderate (≥0.50) to

Discussion

Health-related quality of life increased significantly in most of the patients in the first year after first PM implantation. Almost 70% consider their quality of life completely recovered or much better than before implantation. The most marked differences were seen in the SF-36 subscales “Role limitation due to Physical functioning” and “Change in Health” and the AQUAREL subscale “Arrhythmias.” Remarkably, the patients' “General Health” does not appear to be different between pre- and

Conclusion

In most patients receiving a PM, HRQoL increased in the first year after PM implantation. Almost 70% of patients consider their HRQoL much better or even completely recovered. The most important predictors of HRQoL after 1 year are the HRQoL at baseline, patients' age, cardiac comorbidities at baseline, and atrial fibrillation as the indication for PM implantation. These predictors may aid physicians to discern between patients who will most likely benefit from PM implantation and those in whom

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    The FOLLOWPACE study is granted by the Dutch College of Health Care and Health Insurances (Diemen, The Netherlands) (CVZ/VAZ grant number 01236); the Netherlands Pacemaker Registry Foundation (Groningen, The Netherlands); the Jacques H. de Jong foundation (Nieuwegein, The Netherlands), the Rodger Crowson foundation for Cardiac Arrhythmias Studies (Odijk, The Netherlands), and all Dutch pacemaker distributors and manufacturers.

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