Risk factors and incidence of new-onset heart failure with conventional pacemakerimplant – a nationwide study

Background
Studies have shown that the risk of new-onset heart failure (HF) is higher post-implant for patients receiving right ventricular pacing.

Objective
This study aimed to investigate incidence, risk factors and implications for long-term prognosis of new-onset HF in patients after pacemaker-implant.

Methods
Patients without preexisting HF who received a pacemaker in Sweden during the period 2005-2020 were identified via the nationwide Pacemaker Registry. Data was crossmatched with the population registry and national disease registries. Primary outcome was new-onset HF within 5 years, and a risk score for this was developed and validated..

Results
In all, 65579 patients met the inclusion criteria (10351 single chamber ventricular and 55228 dual chamber pacemakers). 13792 (21.0%) patients were diagnosed with HF within five years post-implant. Of these, 6244 (45.3%) were hospitalized for HF. Patients with new-onset heart failure were more likely to die within five years (41.2% vs. 19.7%, p<0.0001). Risk factors for new-onset HF included increasing age, male sex, hypertension, diabetes, atrial fibrillation, chronic lung- and kidney disease, ischemic heart disease, and AV block. In a combined score using these variables, patients in the highest risk-score quartile had a hazard ratio of 5.36 [4.91-5.86] (p<0.001) and an absolute risk of 32% for developing HF.

Conclusion
Pacemaker therapy is associated with >20% risk of new-onset HF within five years, and we identified nine risk factors associated with the diagnosis of new-onset HF. The proposed score based on these variables can be used to identify patients at high risk for new-onset heart failure