Management of patients with implantable cardioverter defibrillators at emergency departments
Journal
Emergency Medicine Journal
Journal Volume
24
Journal Issue
2
Pages
106-109
Date Issued
2007
Author(s)
Abstract
Background: With rapid improvements in technology and accumulation of clinical evidence, the implantable cardioverter defibrillator (ICD) has become a standard treatment for either primary or secondary prevention of sudden cardiac death. However, no analysis based on the perspective of emergency department has been reported, and managing patients with ICD remains a challenge to the emergency department doctors. Methods: This study reviewed the emergency department visits of patients who received ICD implantation in a single university hospital from 1995 to 2004. The baseline demographic and laboratory data were compared between groups with the non-parametric method of the Mann-Whitney U test for continuous data and the χ2 test for categorical data; p<0.05 was considered significant. Results: 81 patients (56 men and 25 women) were included in this study. 43% of patients had at least one emergency department visit during the follow-up period, and a total of 86 emergency department visits were recorded. The most frequent aetiology of emergency department visits was ICD discharge (37 episodes; 43.1%) and the most frequent presenting symptom was electric shock sensation (25 episodes; 29.1%). Only 11 (12.8%) emergency department visits were because of non-cardiac aetiologies. Patients with emergency department visits had significant lower left ventricular ejection fraction (mean (SD) 41.5 (19.8) v 55.2 (18.4) ejection fraction units; p = 0.005) and more use of warfarin (8.6% v 0%; p<0.05). Although most emergency department visits were device or arrhythmia related, the acute coronary syndrome and congestive heart failure still accounted for 27.9% of hospital returns in combination. Conclusions: Defibrillator discharge, acute coronary syndrome and heart failure constitute most aetiologies of emergency department visits of patients with ICD. The risk factors include lower left ventricular ejection fraction and use of warfarin.
SDGs
Other Subjects
acetylsalicylic acid; antiarrhythmic agent; warfarin; acute coronary syndrome; adolescent; adult; aged; anticoagulant therapy; chi square test; congestive heart failure; controlled study; defibrillator; demography; electric shock; emergency medicine; emergency ward; female; follow up; frequency analysis; heart arrhythmia; heart left ventricle ejection fraction; heart ventricle fibrillation; heart ventricle tachycardia; human; laboratory test; major clinical study; male; medical documentation; nonparametric test; priority journal; rank sum test; review; risk factor; school child; Taiwan; university hospital; Death, Sudden, Cardiac; Defibrillators, Implantable; Electric Injuries; Emergency Service, Hospital; Female; Heart Diseases; Humans; Male
Type
review