# Procedural Complications and Inpatient Outcomes of Leadless Pacemaker Implantations in Rural Versus Urban Hospitals in the United States

## TL;DR

This study compares outcomes of leadless pacemaker implantations in rural and urban US hospitals, finding differences in complications and mortality.

## Contribution

The study is the first to investigate leadless pacemaker outcomes and complications in rural versus urban hospitals in the US.

## Key findings

- Rural hospitals had lower odds of major complications but higher inpatient mortality after leadless pacemaker implantation.
- Rural hospital patients had shorter lengths of stay and lower hospitalization costs.
- Most leadless pacemaker implantations occurred in urban hospitals.

## Abstract

Disparities in invasive cardiovascular care and outcomes in rural and urban hospitals across the United States have been reported. However, studies investigating disparities regarding leadless pacemaker outcomes and complications based on hospital location are lacking.

To evaluate differences in outcomes and complications related to leadless pacemaker implantations among rural and urban hospitals.

The National Inpatient Sample was used to identify patients who underwent leadless pacemaker implantations in the United States from 2016 to 2020. Study endpoints assessed included procedural complications and inpatient outcomes of leadless pacemaker implantations among rural and urban hospitals.

From 2016 to 2020, there were a total of 28 340 and 665 leadless pacemaker implantations in urban and rural hospitals, respectively. Baseline characteristics were similar among both groups, with notable exceptions of higher rates of coagulopathies (13.2% vs. 6.8%, p < 0.001) and peripheral vascular disorders (10.4% vs. 4.5%, p < 0.001) among urban patients. After multivariable adjustment for confounding variables, leadless pacemaker placements occurring in rural hospitals had lower odds of major complications (aOR 0.59, 95% CI 0.41–0.86), but increased odds of inpatient mortality (aOR 1.70, 95% CI 1.21–2.40). Overall, rural leadless pacemaker recipients experienced lower rates of discharge to home, as well as lower costs and length of stay.

A majority of leadless pacemaker implantations occurred in urban hospitals in the United States. Important differences in outcomes were described based on urban and rural hospital location. Further investigation and policy changes are encouraged to promote improved cardiovascular care and outcomes in rural residents.

A majority of leadless pacemaker implantations occurred in an urban hospital setting as compared to a rural hospital.Rural leadless pacemaker recipients had similar rates of co‐morbidities, lower rates of major complications, but higher rates of mortality in the crude analysis.Rural hospital location was independently associated with increased mortality, decreased length of stay and decreased hospitalization cost after leadless pacemaker implantation.

A majority of leadless pacemaker implantations occurred in an urban hospital setting as compared to a rural hospital.

Rural leadless pacemaker recipients had similar rates of co‐morbidities, lower rates of major complications, but higher rates of mortality in the crude analysis.

Rural hospital location was independently associated with increased mortality, decreased length of stay and decreased hospitalization cost after leadless pacemaker implantation.