Background: Pacemakers are an essential tool in managing bradyarrhythmias. Using the large Nationwide Inpatient Sample (NIS) database, we evaluated complications, trends and mortality rates of pacemakers over 2016 2020. Methods: We utilized International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding for our study. We evaluated clinical predictors, complications and mortality of pacemakers using the NIS database. Results: Significant independent Clinical predicators for pacer insertion are: NSTEMI: OR, 1.85; 95% CI, 1.80–1.91; p<0.001, hypertension: OR, 4.26; 95% CI, 4.19–4.34; p<0.001, hyperlipidemia: OR, 3.01; 95% CI, 2.97–3.05; p<0.001, atrial fibrillation/flutter: OR, 4.68 95% CI, 4.62–4.74; p<0.001, diabetes: OR, 1.49; 95% CI, 1.47–1.51; p<0.001, chronic kidney disease: OR, 1.99; 95% CI, 1.97–2.02; p<0.001, smoking: OR, 1.41; 95% CI, 1.31–1.43; p<0.001, COPD: OR, 1.11; 95% CI, 1.09–1.13; p<0.001, valvular heart disease: OR, 5.31; 95% CI, 5.21–5.41; p<0.001, systolic heart failure: OR, 1.98; 95% CI, 1.94–2.02; p<0.001, prior PCI: OR, 2.30; 95% CI, 2.26–2.34; p<0.001, obesity 1.19; 95% CI, 1.17–1.22; p<0.001), history of CABG{:OR, 2.48; 95% CI, 2.43–2.52; p<0.001, STEMI: OR, 1.86; 95% CI, 1.79–1.93; p<0.001, history of cardiomyopathy: OR, 1.90; 95% CI, 1.78–2.03; p<0.001, and endocarditis: OR, 1.77; 95% CI, 1.53–2.04; p<0.001. Pacemaker complication rates is around 2% Mortality around 1.44% Conclusion: We found many predictors for the need of pacemaker insertion. Mortality and complications have remained low over recent years.