Patient preferences for features associated with leadless versus conventional transvenous cardiac pacemakers
Regulatory approval of the first dual-chamber leadless pacemaker (PM) system provides patients an alternative to conventional transvenous pacemakers. To quantify patients’ preferences for pacemaker features. Patients with a de-novo PM indication were recruited from 7 US sites to complete a discrete-choice experiment (DCE) survey. Patients chose between pairs of experimentally designed, hypothetical PMs that varied according to PM type (removable leadless, non-removable leadless, conventional transvenous); battery life (5, 8, 12, 15 years); time since regulatory approval (2, 10 years); discomfort for 6 months (none, discomfort); complication risk and infection risk (1%, 5%, 10%/20% for each). Patients with a de-novo pacemaker indication were recruited to complete a web-based survey from seven US sites between May 11, 2022 to May 24, 2023. Choice data from 117 patients indicated that complication risks and infection risks were the most influential. On average, patients preferred removable leadless pacemakers over both non-removable leadless pacemakers ( p =0.001) and conventional transvenous pacemakers ( p =0.031). However, latent-class analysis revealed two distinct preference classes. One class preferred leadless pacemakers (50.5%) and the other class preferred conventional transvenous pacemakers (49.5%). The conventional PM class prioritized pacemakers with ten rather than two years since regulatory approval ( p <0.001) whereas the leadless PM class was insensitive to years since regulatory approval ( p =0.83). All else equal, patients would accept maximum risks of complications or infections ranging about 5% to 18% to receive their preferred pacemaker type. Latent-class analysis revealed strong patient preferences for the type of PM, with a nearly equal split between recent leadless PM technology and conventional transvenous PMs. These findings can inform shared decision making between healthcare providers and patients.
