{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T18:32:01Z","timestamp":1786386721695,"version":"build-2736575974"},"reference-count":15,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2026,8]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Permanent pacemaker (PPM) implantation is recommended in patients with sinus node dysfunction (SND). In patients with coexisting heart failure with preserved ejection fraction (HFpEF), clinicians may be hesitant to treat SND due to concerns about exacerbating heart failure. Little is known about real\u2010world PPM utilization and disease burden in the HFpEF population that has been assumed to benefit from low heart rates. This study aims to characterize the disease burden and PPM utilization in patients with SND+HFpEF versus SND\u2010only in a Medicare population.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Patients diagnosed with SND were identified in the Medicare administrative claims database and stratified by presence or abscence of prior evidence of HFpEF. Rates of the following clinical outcomes were compared between the cohorts during follow\u2010up: PPM implant, HF hospitalization, atrial fibrillation (AF) hospitalization, second\/third\u2010degree AV block or HFrEF, myocardial infarction (MI), ischemic stroke, and all\u2010cause mortality.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n SND+HFpEF (\n N\u00a0<\/jats:italic>\n =\u00a026,986) patients were older (81.1\u00a0vs. 78.5,\n p<\/jats:italic>\n \u00a0<\u00a00.0001) and more likely to be female (63.5%\u00a0vs. 49.9%,\n p<\/jats:italic>\n \u00a0<\u00a00.0001) than SND\u2010only patients (\n N<\/jats:italic>\n \u00a0=\u00a074,269). Median follow\u2010up time was 884 days (IQR 476\u20131408). The PPM implant rate during follow\u2010up was lower in the SND+HFpEF population (HR\u00a0=\u00a00.811,\n p<\/jats:italic>\n \u00a0<\u00a00.0001). The SND+HFpEF population had higher HF and AF hospitalizations (HR\u00a0=\u00a02.229 and HR\u00a0=\u00a01.174, both p\u00a0<\u00a00.0001), and higher incidence of second\/third\u2010degree AV block and HFrEF (HR\u00a0=\u00a01.364 and HR\u00a0=\u00a01.640, both\n p<\/jats:italic>\n \u00a0<\u00a00.0001) than the SND\u2010only population.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n PPM implant rates were lower, and overall disease burden was greater in HFpEF+SND patients compared to SND\u2010only patients. Future work should focus on optimizing treatment pathways for patients with HFpEF and SND.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/pace.70172","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T20:51:49Z","timestamp":1773003109000},"page":"1015-1022","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real\u2010World Treatment of Patients With Sinus Node Dysfunction and Heart Failure With Preserved Ejection Fraction"],"prefix":"10.1111","volume":"49","author":[{"given":"Nicole","family":"Habel","sequence":"first","affiliation":[{"name":"University of Vermont Medical Center Burlington Vermont USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Rosemas","sequence":"additional","affiliation":[{"name":"Medtronic, Cardiac Rhythm Management Mounds View Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas","family":"Higuera","sequence":"additional","affiliation":[{"name":"Medtronic, Cardiac Rhythm Management Mounds View Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Zimmerman","sequence":"additional","affiliation":[{"name":"Medtronic, Cardiac Rhythm Management Mounds View Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Meyer","sequence":"additional","affiliation":[{"name":"University of MN Dept of Medicine, Cardiovascular Division Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"key":"e_1_2_9_2_1","first-page":"e895","article-title":"AHA\/ACC\/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"145","author":"Heidenreich P. A.","year":"2022","journal-title":"Circulation"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwq433"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11897-013-0155-7"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.119.041886"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehm554"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.118.034646"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2024.08.064"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.119.006213"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.716886"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.017215"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2022.5320"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcrp.2023.200182"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2024.01.036"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaccas.2024.102665"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70172","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pace.70172","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70172","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T18:27:13Z","timestamp":1786386433000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.70172"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,26]]},"references-count":15,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1111\/pace.70172"],"URL":"https:\/\/doi.org\/10.1111\/pace.70172","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,26]]},"assertion":[{"value":"2025-09-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}