Comprehensive Geriatric Assessment Helpful at Pacemaker Implantation

In older adults undergoing pacemaker implantation, a comprehensive geriatric assessment is useful for identifying functional deficits associated with mortality and nursing home admission after the procedure, according to a study published in BMC Geriatrics.

“Though a recent position paper on pacemaker management suggests performing geriatric assessment in older patients, it is only rarely used in clinical routine,” researchers wrote. “This underuse may be partially explained by a lack of good evidence in current literature.”

The prospective study evaluated the use of comprehensive geriatric assessment in 197 patients in Lucerne, Switzerland, who were age 75 years or older at pacemaker implantation. The assessment, which spanned cognition, mobility, nutrition, activities of daily living, and falls, was conducted at pacemaker implantation and annually afterward.

After an average follow-up of 2.4 years, incidence rates of syncope decreased from 0.46 before pacemaker implantation to 0.04 events per year, according to the study. Falls without loss of consciousness decreased from 0.27 to 0.15 events per year.

Impaired mobility, malnutrition, and a higher Charlson comorbidity index at baseline were significant predictors of dying after pacemaker implantation. Comprehensive geriatric assessment, researchers noted, is suited to detect such functional deficits.

Among 169 patients who survived for more than a year and underwent follow-up comprehensive geriatric assessment, a decline in activities of daily living was the strongest predictor of nursing home admission. Older age and a higher Charlson comorbidity index score at pacemaker implantation were associated with an activities of daily living decline during follow-up.

“The present study seems to support the use of comprehensive geriatric assessment in older patients undergoing pacemaker implantation,” researchers concluded, “as functional deficits and falls are amenable to geriatric interventions.”

—Jolynn Tumolo

Reference: 

Schoenenberger AW, Russi I, Berte B, et al. Evaluation of comprehensive geriatric assessment in older patients undergoing pacemaker implantation. BMC Geriatr. 2020;20(1):287. Published 2020 Aug 12. doi:10.1186/s12877-020-01685-7