{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T02:44:12Z","timestamp":1783824252508,"version":"3.55.0"},"reference-count":19,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,4,16]],"date-time":"2021-04-16T00:00:00Z","timestamp":1618531200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>In the United States 2018 bradycardia guideline, the current class III recommendation that patients with permanent pacemaker (PPM) indications and high multimorbidity burden may not have meaningful clinical benefit from PPM therapy is based on limited data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Observational study (January 1, 2008\u2013December 31, 2015) of adults \u226565 years (<jats:italic>N<\/jats:italic>\u00a0=\u00a016,678) who underwent PPM implantation. Exposure variable: Elixhauser comorbidity number (ECN, 29 well\u2010validated conditions). Primary outcome: \u22641\u2010year mortality; secondary outcome:\u00a0&gt;\u00a01\u2010year mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Those who died \u22641\u2010year were older, had a lower body mass index (BMI), and higher ECN (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001). Cumulative survival at 1\u2010year was 92.3% (95% confidence interval [CI]: 91.9\u201392.7). One\u2010year survival decreased by increasing ECN\u2014with a difference at 1\u2010year between lowest and highest ECN category of 17.3% (ECN 0\u20131: 97.1% [95% CI: 96.3\u201397.7]; ECN \u22658: 79.8% [95% CI: 77.9\u201381.5]). For those who survived the first year, cumulative survival at 8\u2010years was 51.2% (95% CI\u00a0=\u00a049.8\u201352.6) with a difference between ECN 0\u20131 and \u22658 of 43.4%. Increasing ECN was associated equally with \u22641\u2010year (HR 1.28 [95% CI: 1.25\u20131.30]) and\u00a0&gt;1\u2010year (HR 1.19 [95% CI: 1.17\u20131.20]) mortality. A predictive model including age, sex, BMI, PPM type, race, and ECN had greater discriminative ability (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.0001) than a bedside model (age, sex) for the primary outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Across the heterogeneity of indications for PPM placement, multimorbidity is increasingly common. The association of multimorbidity to mortality (\u22641\u2010year,\u00a0&gt;1\u2010year) should be routinely discussed during the shared decision\u2010making process as an important prognostic geriatric domain variable.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pace.14238","type":"journal-article","created":{"date-parts":[[2021,4,7]],"date-time":"2021-04-07T05:51:44Z","timestamp":1617774704000},"page":"919-928","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The association of multimorbidity to mortality in older adults after permanent pacemaker placement"],"prefix":"10.1111","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7892-0726","authenticated-orcid":false,"given":"Ashok","family":"Krishnaswami","sequence":"first","affiliation":[{"name":"Division of Cardiology Kaiser Permanente San Jose Medical Center  San Jose California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taylor I.","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Cardiac Electrophysiology Kaiser Permanente Santa Clara  Santa Clara California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Harris","sequence":"additional","affiliation":[{"name":"Surgical Outcomes and Analysis, Kaiser Permanente  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather A.","family":"Prentice","sequence":"additional","affiliation":[{"name":"Surgical Outcomes and Analysis, Kaiser Permanente  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth W.","family":"Paxton","sequence":"additional","affiliation":[{"name":"Surgical Outcomes and Analysis, Kaiser Permanente  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederick A.","family":"Masoudi","sequence":"additional","affiliation":[{"name":"Division of Cardiology University of Colorado Anschutz Medical Campus  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,4,16]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.10.044"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.07.017"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.03.022"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2016.03.019"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.115.002798"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.287.19.2519"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.7812\/TPP\/12-031"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199801000-00004"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000182534.19832.83"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4614-1353-0"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/0-387-29150-4"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.14979"},{"key":"e_1_2_11_14_1","first-page":"880","article-title":"Pacemaker 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