Risk Factors and Costs Associated With 1-Year Mortality and Readmission After Leadless Pacemaker Implantation.

Abstract

Background: Leadless pacemakers (LPM) have been shown to be safe and effective alternatives to transvenous pacing systems. Few studies have evaluated the incidence and associated costs of post-implant complications. The objectives of this study were to assess risk factors and causes for 1-year mortality and all-cause readmission, as well as characterize the total cost of care associated with index procedures and readmissions.

Methods: LPM procedures, including inpatient and outpatient encounters, were captured in the Healthcare Cost and Utilization Project data in Florida, Maryland, and New York from 2016 to 2020 with 1-year follow-up through 2021. Cox proportional hazards regression was used to identify patient demographics, facility volume, and comorbid risk factors for 1-year all-cause readmission and in-hospital mortality. Costs of inpatient cases and readmission were captured.

Methods: Among 7127 patients receiving LPM, 3% died during the initial episode of care. The 1-year all-cause readmission rate was 45.9%, and the in-hospital mortality rate was 8.8%. Comorbid heart failure (CHF), atrial fibrillation/flutter, chronic kidney disease, and diabetes increased the risk of 1-year all-cause readmission and in-hospital mortality (p < 0.05). CHF was the most common cause of readmission (17%). Inpatient cases resulted in a cost of $257 million, with readmissions increasing costs by 44.4%.

Conclusions: The large healthcare expenditure derives from high rates of readmission and in-hospital mortality, with readmissions potentially representing a modifiable target. CHF is a prominent cause of poor outcomes, which suggests the need to consider the overlapping roles of conduction system pacing, goal-directed medical therapy, and close clinical follow-up.