Implantable cardioverter defibrillators and permanent pacemakers: prevalence and patient outcomes after trauma.
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.
Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, 100 Nichols Road, HSC T18-040, Stony Brook, NY, USA.
Maria S
MS
Altieri
Division of Cardiology, Department of Internal Medicine, Stony Brook University School of Medicine, Stony Brook, NY, USA.
Ibrahim
I
Almasry
Stony Brook University School of Medicine, Stony Brook, NY, USA.
Tyler
T
Jones
Stony Brook University School of Medicine, Stony Brook, NY, USA.
Christa
C
McPhee
Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, 100 Nichols Road, HSC T18-040, Stony Brook, NY, USA.
Jane E
JE
McCormack
Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, 100 Nichols Road, HSC T18-040, Stony Brook, NY, USA.
Emily C
EC
Huang
Stony Brook University School of Nursing, Stony Brook, NY, USA; Heilbrunn Family Center for Research Nursing, Rockefeller University, New York, NY, USA.
Patricia
P
Eckardt
Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, 100 Nichols Road, HSC T18-040, Stony Brook, NY, USA.
Marc J
MJ
Shapiro
Nursing Administration, John T. Mather Hospital, Port Jefferson, NY, USA.
Sarah
S
Eckardt
Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, 100 Nichols Road, HSC T18-040, Stony Brook, NY, USA.
James A
JA
Vosswinkel
Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, 100 Nichols Road, HSC T18-040, Stony Brook, NY, USA. Electronic address: randeep.jawa@stonybrookmedicine.edu.
Randeep S
RS
Jawa
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D017147:Defibrillators, Implantable / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial / Q000009:adverse effects* / Q000706:statistics & numerical data; D015995:Prevalence; D057216:Propensity Score; D012042:Registries; D018570:Risk Assessment; D016019:Survival Analysis; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*
ICD; Implantable cardiac device; Pacemaker; Trauma