Pacemakers Used More Often in Vulnerable Patients

Dementia and mild cognitive impairment patients were more likely to receive pacemakers

(RxWiki News) Pacemakers are a time-tested and effective way to safely adjust irregular heart rate with a small medical implant. But the devices do come with risks and benefits that must be carefully considered.

A new study found patients with dementia and mild cognitive impairment (MCI) were more likely than those with no impairment to be treated with pacemakers.

The study authors called for more research into why this was so, since the authors expectation was that patients who were cognitively disabled might be treated less aggressively.

"Discuss potential cognitive problems with a cardiologist before treatment."

The study was conducted by Nicole R. Fowler, PhD, MHSA, of the Division of Internal Medicine at the University of Pittsburgh School of Medicine, and colleagues.

Dr. Fowler and team used data from the National Alzheimer's Coordinating Center on 16,245 patients. The researchers gathered the data between September 2005 and December 2011.

They set out to analyze how often pacemakers were recommended to treat irregular heart rates for patients with MCI or dementia — as compared to patients with no cognitive function problems.

With MCI, patients may have memory loss, but it is not severe enough to impact daily life. Dementia is more severe and can make living independently harder.

Pacemakers are medical devices placed in the chest or abdomen that use electrical pulses to regulate heart rate. They are usually reserved for patients without other serious illnesses like dementia or MCI, the researchers noted.

Of the 16,245 study participants, 7,446 (45.8 percent) had no cognitive problems, and 3,460 (21.3 percent) had MCI. The remaining 5,339 (32.9 percent) had dementia.

Participants with dementia were 1.6 times more likely to receive a pacemaker than participants without cognitive impairment. The group with MCI was 1.2 times more likely to receive a pacemaker than the group without memory loss and other symptoms.

In the control group without cognitive problems, 4 of every 1,000 patients received pacemakers. Of the patients with MCI, 4.7 out of 1,000 got pacemakers — compared to 6.5 for every 1,000 in the dementia group.

Dr. Fowler and colleagues pointed out that aggressive treatment like a pacemaker is usually reserved for patients who can, for the most part, look after themselves.

“Patients with dementia were more likely to receive a pacemaker than patients without cognitive impairment, even after adjusting for clinical risk factors,” they wrote. “This runs counter to the normative expectation that patients with a serious life-limiting and cognitively disabling illness might be treated less aggressively.”

The researchers called for future research into the decision-making influences that go into using a pacemaker on patients with cognitive problems.

The research letter was published online July 28 in the peer-reviewed journal JAMA Internal Medicine.

Funding was provided by the Agency for Healthcare Research and Quality, the National Institutes of Health and the National Institute on Aging.

The authors did not disclose any conflicts of interest.

Review Date: 
July 28, 2014