Abstract
ABSTRACT
Background
Consensus‐recommended follow‐up after cardiac implantable electronic device (CIED) implantation improves outcomes, yet whether it mediates cardiovascular disparities between device types remains unknown.
Methods
We prospectively studied 6806 patients undergoing CIED implantation across a multi‐hospital system (2019–2023; median follow‐up 3.5 years), categorized as implantable cardioverter defibrillator (ICD) (
n
= 2757) or permanent pacemaker (PPM) (
n
= 4049). Causal mediation analysis decomposed the effect of device type on major adverse cardiovascular events (MACE) and device extraction into direct and follow‐up mediated components, adjusting for demographics and comorbidities.
Results
ICD recipients had significantly lower consensus‐recommended follow‐up rates than PPM recipients (65.3% vs. 79.2%; adjusted OR 0.46, 95% CI 0.40–0.52,
p
p
Conclusions
More than half of the excess cardiovascular risk in ICD recipients was statistically mediated by suboptimal follow‐up adherence—a potentially modifiable pathway. These findings identify follow‐up adherence as a potentially important pathway and support further prospective investigation of strategies to improve monitoring and clinical outcomes in high‐risk CIED populations.