Modifiable predictors of atrioventricular block warranting a pacemaker: A cohort study.

Among 28,640,453 patients followed over a mean of 9.8 years, 0.3% received a pacemaker for AV block.

• Mean age was 44.2 ± 19.3 years; 54% were female.
• Mean follow-up was 9.8 ± 4.8 years.
• Data were drawn from California Health Care Access and Information databases for the period 2005–2020.
• The cohort included Californians ≥18 years who received care in an emergency department, outpatient surgery facility, or hospital.

19 predictors were independently associated with an increased risk of pacemaker implantation for AV block in the fully adjusted model.

• Predictors included older age, male sex, and multiple cardiovascular comorbidities.
• Modifiable lifestyle factors identified included heavy alcohol use, tobacco use, cannabis consumption, and obesity.
• Multivariable adjusted Cox proportional hazard models were used to identify predictors.
• Outcome and covariates were identified using ICD-9, ICD-10, and CPT codes.

Modifiable lifestyle factors—heavy alcohol use, tobacco use, cannabis consumption, and obesity—were each associated with an increased risk of AV block warranting a pacemaker.

• These factors were identified in the fully adjusted multivariable Cox proportional hazard model.
• These findings parallel recent studies showing modifiable risk factors influence atrial fibrillation and other cardiac arrhythmias.
• The study aimed to determine whether similar modifiable predictors relevant to atrial fibrillation also apply to bradyarrhythmias.
• Cannabis consumption was specifically identified as a modifiable predictor, suggesting a novel association warranting further investigation.

Asian and Pacific Islanders and Black patients were at lower risk of AV block warranting a pacemaker compared to White patients.

• Racial differences in risk were identified in the fully adjusted multivariable model.
• White race was used as the reference category for racial/ethnic comparisons.
• Demographics were examined alongside comorbidities, lifestyle factors, and air pollution levels as potential predictors.
• The lower risk in these groups remained after multivariable adjustment.

Cardiovascular comorbidities were among the significant predictors of pacemaker implantation for AV block.

• Cardiovascular comorbidities were included alongside demographics and lifestyle factors as potential predictors.
• They were identified as predictors in the fully adjusted Cox proportional hazard model.
• The study examined a broad set of demographics, comorbidities, lifestyle factors, and air pollution levels.
• Specific cardiovascular comorbidities associated with increased risk were identified using ICD-9 and ICD-10 codes.

Air pollution levels were examined as a potential predictor of AV block warranting a pacemaker alongside other demographic and lifestyle factors.

• Air pollution was included as one of the candidate predictors in the multivariable models.
• The study used California Health Care Access and Information databases, allowing linkage of clinical and environmental exposure data.
• The study population covered Californians receiving care from 2005 to 2020, providing a geographically diverse sample for air pollution analysis.