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Published on: February 28, 2012
Implantable cardioverter defibrillators and permanent pacemakers: prevalence and patient outcomes after trauma
Maria S Altieri1, Ibrahim Almasry2, Tyler Jones3
1Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, 100 Nichols Road, HSC T18-040, Stony Brook, NY, USA.
Insights
Older trauma patients with cardiac devices like implantable cardioverter defibrillators (ICDs) and permanent pacemakers (PPMs) have higher mortality. These devices identify patients with comorbidities, not independent predictors of death.
Area of Science:
- Trauma surgery
- Cardiology
- Geriatric medicine
Background:
- Prevalence and outcomes of cardiac device use in older trauma patients are not well-documented.
- Implantable cardioverter defibrillators (ICDs) and permanent pacemakers (PPMs) are common in elderly populations.
Purpose of the Study:
- To determine the prevalence and outcomes of older trauma patients (≥ 60 years) with ICDs or PPMs.
- To analyze the impact of cardiac devices on mortality in this demographic.
Main Methods:
- Retrospective review of a regional trauma registry (2007-2014).
- Inclusion criteria: blunt trauma, age ≥ 60 years.
- Comparison of outcomes between patients with ICDs, PPMs, and no cardiac devices.
Main Results:
- Approximately 9% of older trauma admissions had cardiac devices (146 ICDs, 233 PPMs).
- Patients with ICDs (13.0%) and PPMs (8.6%) exhibited significantly higher mortality rates compared to those without devices (5.6%).
- Cardiac devices were not independent predictors of mortality; they indicated underlying comorbidities.
Conclusions:
- Cardiac device presence in older trauma patients is associated with increased mortality, primarily due to underlying cardiac dysfunction and comorbidities.
- Intracranial hemorrhage was the leading cause of death in cardiac device patients.
- Proper functioning of cardiac devices was confirmed in deceased patients.
Background:
The prevalence and outcomes of older trauma patients with implantable cardioverter defibrillators (ICDs) or permanent pacemakers (PPMs) is unknown.
Methods:
The trauma registry at a regional trauma center was reviewed for blunt trauma patients, aged ≥ 60 years, admitted between 2007 and 2014. Medical records of cardiac devices patients were reviewed.
Results:
Of 4,193 admissions, there were 146 ICD, 233 PPM, and 3,814 no device patients; median Injury Severity Score was 9. Most cardiac device patients had substantial underlying heart disease. Patients with ICDs (13.0%) and PPMs (8.6%) had higher mortality rates than no device patients (5.6%, P = .0002). Among cardiac device patients who died, the device was functioning properly in all that were interrogated; the most common cause of death was intracranial hemorrhage. On propensity score analysis, cardiac devices were not independent predictors of mortality but rather surrogate variables associated with other predictors of mortality.
Conclusions:
Approximately 9.0% of admitted older patients had cardiac devices. Their presence identified patients who had higher mortality rates, likely because of their underlying comorbidities, including cardiac dysfunction.
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