Impact of prior pacemaker implantation on length of stay in acute diastolic heart failure: a propensity score-matched analysis.

OBJECTIVES

Permanent pacemakers are widely used to manage symptomatic bradyarrhythmias and conduction disorders; however, their impact on hospitalization outcomes, such as length of stay, in patients with acute decompensated diastolic heart failure remains unclear. This study aimed to assess whether prior pacemaker implantation independently affects hospital length of stay using data from the 2018-2019 National Inpatient Sample database.

METHODS

A total of 14,523 adult patients hospitalized with acute diastolic heart failure were identified, including 855 with a history of pacemaker implantation. Propensity score matching was conducted to adjust for baseline differences, and competing risks regression was performed to account for the competing risk of in-hospital mortality.

RESULTS

Before matching, pacemaker recipients were older and had a higher burden of comorbidities; unadjusted analysis showed a modest but statistically significant association with shorter length of stay (sHR = 1.075; 95% CI: 1.010-1.144; P = 0.023). After matching, this association was attenuated and no longer significant (sHR = 1.081; 95% CI: 0.992-1.178; P = 0.077). Comorbid conditions, particularly chronic kidney disease, liver disease, and pulmonary hypertension, were stronger predictors of prolonged hospitalization.

CONCLUSIONS

These findings suggest that pacemaker status alone does not independently affect the length of stay in patients hospitalized with acute diastolic heart failure, highlighting the importance of managing comorbidities to potentially reduce hospital length of stay in this vulnerable population, although further studies are warranted to confirm these observations.