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Longevity of implantable electrophysiology devices explanted from patients having autopsy in hospitals
Payman Zamani1, James N Kirkpatrick, Leslie A Litzky
1Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA. payman.zamani@uphs.upenn.edu
Insights
Cardiac implantable electrophysiologic devices (CIEDs) are expensive. Hospital morgues could supply CIEDs for reuse programs, offering a potential solution for patients in low-income countries needing these life-saving devices.
Area of Science:
- Biomedical Engineering
- Medical Device Technology
- Public Health
Background:
- Cardiac implantable electrophysiologic devices (CIEDs) are crucial for managing cardiac conditions but are costly.
- Limited data exist on the viability of reusing CIEDs obtained post-mortem from hospital morgues.
Purpose of the Study:
- To assess the feasibility of using explanted CIEDs from hospital autopsies for donation and reuse programs.
- To determine the remaining battery longevity of CIEDs retrieved from deceased patients.
Main Methods:
- Retrospective analysis of 334 autopsies performed at a university morgue.
- Collection and interrogation of explanted CIEDs to determine remaining battery life.
- Cross-referencing device data with electronic medical records for implantation dates and patient information.
Main Results:
- Twenty-seven patients (8%) had CIEDs; 17 were pacemakers and 10 were implantable cardioverter-defibrillators.
- Devices were interrogated 1.7 years post-mortem on average.
- 48% of CIEDs were implanted within one year of the patient's death, with 30% having ≥4 years of estimated battery life remaining.
Conclusions:
- Hospital morgues represent a potential source for CIEDs for reuse programs.
- Patient or next-of-kin authorization is essential for device donation.
- Repurposing CIEDs could improve access for patients in resource-limited settings.
Abstract:
The cost of cardiac implantable electrophysiologic devices (CIEDs) remains prohibitively high for many patients in low- and middle-income countries. Recent efforts have focused on obtaining CIEDs for donation and reuse in low- and middle-income countries from funeral homes and after device upgrades. Most patients in the United States die in health care facilities, yet few data exist on the acceptability for reuse of devices from hospital morgues. Three hundred thirty-four autopsies were performed at the University of Pennsylvania morgue from February 2009 to July 2011, during which CIEDs were routinely removed and collected. Devices were interrogated to ascertain remaining longevity. When a longevity estimate was not provided by the device, the manufacturer was contacted to obtain an estimate. Date of death was obtained from the electronic medical record. Twenty-seven patients (8% of autopsies performed) had CIEDs, of which 17 (63%) were pacemakers and 10 (37%) were implantable cardioverter-defibrillators. Two of the defibrillators were part of cardiac resynchronization therapy systems. CIEDs were interrogated 1.7 ± 0.7 years after death. The mean time between implantation and death was 2.5 ± 2.3 years, but 13 (48%) devices were implanted within 1 year of death. Nine devices (33%) had <1 year of battery life remaining, 10 devices (37%) had an estimated longevity of 1 to 4 years, and 8 devices (30%) had longevity estimates of ≥4 years. In conclusion, a significant percentage of patients who underwent autopsy had CIEDs implanted <1 year before death. Hospital morgues may serve as a source for devices in reuse programs, provided patients or their next of kin authorize donation.
