Elsevier

American Heart Journal

Volume 144, Issue 4, October 2002, Pages 687-692
American Heart Journal

Clinical Investigations: Electrophysiology
Health values before and after pacemaker implantation,☆☆,

https://doi.org/10.1067/mhj.2002.124835Get rights and content

Abstract

Background Health value or utility is the abstracted magnitude of a person's preference for quality and quantity of life. It reflects how much lifetime with the patient's current health condition a patient is willing to exchange for a life in excellent health. Health values are used in cost-effectiveness analysis as a means of calculating quality-adjusted years of life. Objective This study assessed the health values of elderly patients before and after pacemaker implantation. Methods We prospectively examined 398 patients from the Pacemaker Selection in the Elderly study, in which patients were randomized to either VVIR or DDDR mode. Health values were estimated with the time tradeoff method before implantation and at 3, 9, and 18 months after implantation. Results The mean age of patients was 76 ± 6 years; 234 patients (59%) were male. At baseline, patients were, on average, willing to exchange 5 years of current health for approximately 4 years in perfect health (value 0.76 ± 0.06). There was no difference in baseline health values with implant diagnosis (sinus node dysfunction n = 172, 0.72, atrioventricular block n = 227, 0.75, other diagnoses n = 39, 0.78, P = not significant). The overall improvement in health values at 3 months after pacemaker implantation was 0.165 ± 0.4 (P =.0001). The improvement in health values was independent of pacing mode (P =.6). The time tradeoff score was modestly correlated with other measurements of health-related quality of life. The change in time tradeoff score with time was not influenced by demographic characteristics such as age and sex, diagnoses, pacing mode, employment status, or history of angina. Patients with a lower functional class at enrollment (III or IV on the Specific Activity Scale) demonstrated an absolute improvement of 23% in their health values, whereas patients in class I or II improved only by 12%, (P =.03). Conclusions Permanent pacemaker implantation for standard indications improves health values and descriptive health status measures. The values reported here may be used as a means of calculating the cost-effectiveness of different pacing modalities. (Am Heart J 2002;144:687-92.)

Section snippets

Study participants

The Pacemaker Selection in the Elderly (PASE)4 trial was a single-blind, randomized, 29-center controlled trial of ventricular pacing versus dual chamber pacing in 407 patients aged ≥65 years. The primary end point was health-related quality of life. To participate, patients had to be in sinus rhythm at the time of implantation and had to have bradycardia as the indication for a permanent pacemaker. All participants provided written informed consent before participation. Patients were excluded

Results

PASE enrolled 407 patients who were observed for an average of 550 days. The time-tradeoff questionnaire was completed by 398 patients at baseline, by 284 patients at 3 months, by 291 patients at 9 months, and by 250 patients at 18 months of follow-up.

Discussion

This study demonstrated that health values improve after pacemaker implantation and that that improvement is only partially explained with the improvement in other measurements of quality of life. The 2 main approaches to assessing health-related quality of life are descriptive health status and health utility measurement.12, 13 The health status evaluation describes the individual's well being and functioning in 1 or several domains such as health perception, physical functioning, mental

Acknowledgements

We thank Elaine Abrams, the telephone interviewer, without whose determined and careful efforts, these analyses would not have been possible, the PASE coordinators and investigators, and Mrs Lori Saint-Thomas, for her careful secretarial assistance.

References (22)

  • JE Ware et al.

    The MOS 36-item Short-Form Health Survey (SF-36). I. Conceptual framework and item selection

    Med Care

    (1992)
  • Cited by (26)

    • Life expectancy after implantation of a first cardiac permanent pacemaker (1995-2008): A population-based study

      2015, International Journal of Cardiology
      Citation Excerpt :

      This would account for the lower proportion of age-stratified deaths from cancer, stroke and dementia than observed at the national level, albeit on low numbers of patients. Although medical interventions become more complicated and expensive in patients with limited LE due to advanced age [8,18], the oldest patients, in particular, may benefit from improvements in mobility, cognitive function, and activities of daily living [20,21]. Increasing LE and longer follow-up, even for older patients, has been associated with relatively low costs [22], making advanced age alone no argument for not implanting a PPM if indicated.

    • Long term quality-of-life in patients with bradycardia pacemaker implantation

      2013, International Journal of Cardiology
      Citation Excerpt :

      We observed no clear association between maintained AV-synchrony (AAI/DDD) and HRQoL. Initially small, cross-over studies reported better HRQoL when patients had DDD pacing compared to VVI pacing mode [25,31], however more detailed analysis from data of large clinical trials as MOST, CTOPP and PASE, showed no difference in HRQoL between pacing modes [5,32,33]. In addition, other observational studies found no difference in HRQoL between pacing modes [19,20,34].

    • Predictors of improved quality of life 1 year after pacemaker implantation

      2008, American Heart Journal
      Citation Excerpt :

      The results of these questions can be summarized into 3 subscales: chest discomfort, dyspnoe at exertion, and arrhythmias, each ranging from 0 to 100, with lower scores representing a lower HRQoL. We a priori selected a total of 9 possible predictors of HRQoL 1 year after PM implantation based on the existing literature.3,5-7,20-22 These included the patients' sex, age, and presence of several comorbidities (total cardiac comorbidity, coronary pathology, heart failure, and diabetes) assessed at implantation and based on the data in the patients' file, the indication for PM implantation, the used PM chamber system (dual- vs single-chamber pacing), and the occurrence of an adverse event at PM implantation.

    View all citing articles on Scopus

    Supported by a grant from Intermedics, Inc.

    ☆☆

    Reprint requests: Gervasio A. Lamas, MD, Mount Sinai Medical Center, 4300 Alton Rd, Suite 207A, Miami Beach, FL 33140.

    E-mail: [email protected]

    View full text