PITTSBURGH, July 28, 2014 -- People with dementia are more likely to get implanted pacemakers for heart rhythm irregularities, such as atrial fibrillation, than people who don't have cognitive difficulties, according to researchers at the University of Pittsburgh School of Medicine. In a research letter published online today in JAMA Internal Medicine, the researchers noted the finding runs counter to expectations that less aggressive interventions are the norm for patients with the incurable and disabling illness.
To look at the relationships between cognitive status and implantation of a pacemaker, lead investigator Nicole Fowler, Ph.D., a health services researcher formerly at the Pitt School of Medicine, and her team examined data from 33 Alzheimer Disease Centers (ADCs) entered between September 2005 and December 2011 into the National Alzheimer's Coordinating Center (NACC) Uniform Data Set.
Data from more than 16,000 people who had a baseline and at least one follow-up visit at an ADC were reviewed. At baseline, 48.5 percent of participants had no cognitive impairment, 21.3 percent had a mild cognitive impairment (MCI), and 32.9 percent had dementia.
The researchers found that participants with cognitive impairment were significantly older and more likely to be male, have ischemic heart disease, and a history of stroke. Rates of atrial fibrillation and congestive heart failure were similar among the groups.
The likelihood of getting a pacemaker, a device that regulates the heart beat, was lowest for those who had no cognitive difficulties and highest for dementia patients.
"Participants who had dementia before assessment for a new pacemaker were 1.6 times more likely to receive a pacemaker compared to participants without cognitive impairment, even after clinical factors were taken into account," said Dr. Fowler, now at Indiana University. "This was a bit surprising because aggressive interventions might not be appropriate for this population, whose lives are limited by a severely disabling disease. Future research should explore how doctors, patients and families come to make the decision to get a pacemaker."
There was no difference among the groups in the rates of implantation of cardioverter defibrillators, which deliver a small shock to get the heart to start beating again if it suddenly stops.
Co-authors of the paper include Jie Li, M.S., Charity G. Moore, Ph.D., Samir Saba, M.D., Oscar L. Lopez, M.D., and Amber E. Barnato, M.D., M.P.H., M.S., all of the University of Pittsburgh, and Kim G. Johnson, M.D., of Duke University Medical Center.
The project was funded by the Agency for Healthcare Research and Quality and National Institutes of Health, National Institute on Aging grant AG05133. The NACC database is funded by National Institutes of Health, National Institute on Aging grant AG016976.
About the University of Pittsburgh School of Medicine
As one of the nation's leading academic centers for biomedical research, the University of Pittsburgh School of Medicine integrates advanced technology with basic science across a broad range of disciplines in a continuous quest to harness the power of new knowledge and improve the human condition. Driven mainly by the School of Medicine and its affiliates, Pitt has ranked among the top 10 recipients of funding from the National Institutes of Health since 1998. In rankings recently released by the National Science Foundation, Pitt ranked fifth among all American universities in total federal science and engineering research and development support.
Likewise, the School of Medicine is equally committed to advancing the quality and strength of its medical and graduate education programs, for which it is recognized as an innovative leader, and to training highly skilled, compassionate clinicians and creative scientists well-equipped to engage in world-class research. The School of Medicine is the academic partner of UPMC, which has collaborated with the University to raise the standard of medical excellence in Pittsburgh and to position health care as a driving force behind the region's economy. For more information about the School of Medicine, see http://www.medschool.pitt.edu. http://www.upmc.com/media
Journal
JAMA Internal Medicine