September 2, 2014
People who have Alzheimer’s disease and other forms of dementia are more likely to get pacemakers than their peers with similar health issues but without dementia, a new study shows. The study raises questions about whether patients with Alzheimer’s may be getting overly aggressive medical care in some cases.
Pacemakers are typically implanted in the chest in people with heart rhythm disorders like atrial fibrillation, or A-fib. The metal devices, about the size of a pocket watch, keep the heart beating in a normal rhythm and can help to avert a potentially fatal heart attack.
But as with all medical procedures, pacemaker implantation carries side effects and risks, which must be carefully weighed against benefits when deciding whether someone should receive a pacemaker. Some question the appropriateness of implanting devices like pacemakers in frail and elderly individuals who have advanced dementia or other serious medical problems, when quality of life is poor.
For the study, researchers at the University of Pittsburgh School of Medicine analyzed health records from 16,245 people who had been treated at least once at one of 33 Alzheimer’s treatment centers in the United States. Patient records were assessed from 2005 to 2011.
At the start, about a third of the study participants had been given a diagnosis of dementia; 21 percent had mild cognitive impairment, a form of memory loss that sometimes progresses to dementia; and 48 percent had no problems with thinking and memory. Rates of atrial fibrillation and congestive heart failure were similar among the groups.
The researchers found that the likelihood of getting a pacemaker was lowest for those who had no memory problems, and highest for those with dementia. The findings were published in JAMA Internal Medicine, a journal from the American Medical Association.
“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 Nicole Fowler, the study leader, who is 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.”
People with mild cognitive impairment were 1.2 times more likely to get a pacemaker than those with no memory problems. There was no difference among the groups on whether someone received an implantable cardiac defibrillator, another device that can re-set the heart beat if it stops beating.
The study raises interesting questions about the kind of medical care that those with Alzheimer’s or other serious cognitive problems receive. Pacemakers can be lifesaving devices and are appropriate in many cases. But family members and other caregivers, as well as doctors who treat dementia patients, should carefully weigh whether a pacemaker is the right option for a patient with dementia.
“Future research should explore how doctors, patients and families come to make the decision to get a pacemaker,” Dr. Fowler said. “The risks and benefits of device implantation should be weighed carefully by patients with cognitive impairment, family members, and clinicians given the potential of these devices to have an impact on the quantity and quality of life,” the authors note.
Source: Nicole R. Fowler, PhD. Jie Li, M.S., Charity G. Moore, Ph.D., et al: Use of Cardiac Implantable Electronic Devices in Older Adults With Cognitive Impairment. (Research letter.) JAMA Internal Medicine, July 21, 2014.