Results:

The analysis included 8,466 HFpEF patients after exclusions; of these, 682 patients (8%) had permanent pacemakers at baseline. The study authors found that pacemaker patients were older and more often men and had lower body mass indexes, estimated glomerular filtration rates, and blood pressures but higher concentrations of N-terminal pro–B-type natriuretic peptide than those without a pacemaker. Patients with a device had a high prevalence of atrial fibrillation, as well as greater use of digoxin and mineralocorticoid receptor antagonist therapy than patients without a pacemaker. The rate of the primary composite outcome in pacemaker patients was almost twice that in patients without a pacemaker (13.6 vs. 7.6 per 100 patient-years of follow-up, respectively), with a similar finding for HF hospitalizations (10.8 vs. 5.1 per 100 patient-years, respectively). This risk rate persisted after adjusting for other prognostic variables (hazard ratio [HR] for the composite outcome, 1.17; 95% confidence interval [CI], 1.02-1.33; p = 0.026), driven mainly by HF hospitalization (HR, 1.37; 95% CI, 1.12-1.60; p < 0.001). The risk of mortality was not significantly higher in pacemaker patients in the adjusted analyses. There were few differences in the risk of sudden death according to history of pacemaker implantation. By contrast, pump failure death was more common in patients with a pacemaker than in those without (1.8 vs. 0.8 per 100 patient-years, respectively); however, the elevated risk did not persist after adjustment for other prognostic variables (fully adjusted HR, 1.00; 95% CI, 0.70-1.42; p = 0.99).