Quality of life of elderly patients after implantation of two-chamber pacemaker during remote and in-person monitoring

Aim. To compare of the quality of life (QoL) dynamics of elderly and senile patients after primary implantation of two-chamber pacemakers during remote monitoring and in-person control in the clinic.

Material and methods. This prospective study included 95 patients (50.5 % women) with mean age of 72.5 ± 7.9 years who underwent pacemaker implantation. The treatment group (n = 40) was monitored remotely using the CareLink Network (Medtronic, USA) system with data transmitted monthly for one year. The control group (n = 55) underwent in-person follow-ups. Condition and QoL of each group were assessed prior to surgery, on day 5 at discharge from the hospital, one month and one year after the surgery. The comparison groups are statistically comparable in terms of inclusion criteria, which allowed to perform accurate comparative statistical analysis. QoL was assessed using the Aquarel (Assessment of QoL and related events) questionnaire.

Results. In the treatment group, QoL significantly improved at all study stages compared to baseline in the domains of “General”, “Arrhythmia”, “Chest Discomfort” and “Shortness of Breath and Fatigue”, while “Cognitive Functions” improved only after one month and one year. The treatment group showed more pronounced QoL increase (%) at all stages compared to the control group. Analysis of total QoL in relation to detected arrhythmias revealed no statistically significant differences at any stage, either overall (p = 0.776; 0.380; 0.481; 0.067) or in the treatment group alone (p = 0.456; 0.264; 0.128; 0.214). Patients in the remote monitoring group with diabetes mellitus and postinfarction cardiosclerosis showed statistically significant improvement in QoL only after 1 year (p = 0.005 and 0.012, respectively), in contrast to the face-to-face control group. No such differences were observed in patients with acute cerebrovascular accidents. QoL in both groups was not negatively affected by pacemaker-registered paroxysmal tachycardia (episodes of high atrial rhythm, atrial fibrillation, atrial flutter, ventricular tachycardia) identified and verified by a doctor during routine clinical analysis. However, in the patients of the treatment group with episodes of high atrial rhythm, QoL decreased a month later while in the comparison group these changes were reported 5 days after the surgery in cases of atrial flutter.

Conclusion. The study showed an improvement in the QoL of elderly and senile patients after implantation of two-chamber pacemakers. A particularly noticeable increase in the QoL (in %) was observed in the treatment group, where changes were recorded at all stages of observation, for the indicators “Overall”, “Arrhythmia”, “Chest discomfort”, and “Shortness of breath / fatigue”. In the control group, improvements were observed only 5 days and 1 month after surgery. It was found that in patients of the main group with concomitant diseases (diabetes mellitus and postinfarction cardiosclerosis), a statistically significant improvement in the QoL was observed one year later (p <0.05), which was not observed in the control group.