Risk of Pacemaker Implantation After Femur Fracture in Patients with and Without a History Syncope: a Danish Nationwide Registry-based Follow-up Study

Overview

Journal J Geriatr Cardiol

Specialty Geriatrics

Date 2022 Oct 26

PMID 36284681

Authors

Sara Lk Clemmensen

Kristian Kragholm

Bhupendar Tayal

Christian Torp-Pedersen

Soren Kold

Peter Sogaard

Sam Riahi

Affiliations

Soon will be listed here.

Abstract

Background: It has previously been described that fall-associated injuries including fractures are commonly observed among patients with bradyarrhythmia. However, knowledge on the risk of pacemaker implantation after admission due to femur fracture from large population-based epidemiologic data is lacking. Therefore, we investigated the risk of pacemaker implantation following femur fracture in patients with and without a history of previous syncope.

Methods: All patients with femur fracture between 2005-2017 were identified using the Danish Nationwide Patient Registry. Among these, patients already having a pacemaker were excluded. Primary outcome was one-year risk of pacemaker implantation and secondary outcome was one-year all-cause mortality. Multivariable logistic regression was used to obtain absolute and relative risks of the study endpoint in relation to patients with versus without history of syncope and standardized to the age, sex, selected comorbidity and pharmacotherapy distribution of all patients.

Results: Of 93,093 patients with femur fracture, 5508 (5.9%) had a history of syncope within five years. Patients with prior syncope were slightly older (84 . 83 years), more often male (33.6% . 29.4%), and had more often comorbidities relative to those without history of syncope. All-cause mortality was significantly higher among those with previous history of syncope compared to those without previous syncope (29.9% . 28.6%, = 0.021). The relative mortality risk was 1.05 (95% CI: 1.01-1.09, = 0.021). A total of 695 (0.8%) patients underwent pacemaker implantation within 5 years following femur fracture, and a significantly higher proportion of patients with syncope had a pacemaker implanted within one year (1.6% . 0.7%, < 0.001; relative risk, 2.01 [95% CI: 1.55-2.46]).

Conclusions: In patients with femur fracture, a history of syncope was significantly associated with a higher one-year risk of pacemaker implantation.

Citing Articles

The syncope core management process in the emergency department: a consensus statement of the EUSEM syncope group.

Mockel M, Catherine Janssens K, Pudasaini S, Riesgo L, Moya Torrecilla F, Golea A Eur J Emerg Med. 2024; 31(4):250-259.

PMID: 38874507 PMC: 11198953. DOI: 10.1097/MEJ.0000000000001146.

References

Nume A, Carlson N, Gerds T, Holm E, Pallisgaard J, Sondergaard K . Risk of post-discharge fall-related injuries among adult patients with syncope: A nationwide cohort study. PLoS One. 2018; 13(11):e0206936. PMC: 6248940. DOI: 10.1371/journal.pone.0206936. View

Hartholt K, Van der Velde N, Looman C, Van Lieshout E, Panneman M, van Beeck E . Trends in fall-related hospital admissions in older persons in the Netherlands. Arch Intern Med. 2010; 170(10):905-11. DOI: 10.1001/archinternmed.2010.106. View

Badila E, Negrea C, Ripa A, Weiss E, Bartos D, Tirziu C . The Etiology of Syncope in an Emergency Hospital. Rom J Intern Med. 2016; 54(3):173-178. DOI: 10.1515/rjim-2016-0023. View

Hjelholt T, Edwards N, Vesterager J, Kristensen P, Pedersen A . The Positive Predictive Value of Hip Fracture Diagnoses and Surgical Procedure Codes in the Danish Multidisciplinary Hip Fracture Registry and the Danish National Patient Registry. Clin Epidemiol. 2020; 12:123-131. PMC: 7007794. DOI: 10.2147/CLEP.S238722. View

McIntosh S, Lawson J, Kenny R . Clinical characteristics of vasodepressor, cardioinhibitory, and mixed carotid sinus syndrome in the elderly. Am J Med. 1993; 95(2):203-8. DOI: 10.1016/0002-9343(93)90261-m. View

Jansen S, Kenny R, de Rooij S, Van der Velde N . Self-reported cardiovascular conditions are associated with falls and syncope in community-dwelling older adults. Age Ageing. 2014; 44(3):525-9. DOI: 10.1093/ageing/afu164. View

Jansen S, Frewen J, Finucane C, de Rooij S, Van der Velde N, Kenny R . AF is associated with self-reported syncope and falls in a general population cohort. Age Ageing. 2015; 44(4):598-603. DOI: 10.1093/ageing/afv017. View

Qian X, Pan Y, Chen J, Jiang Q, Huang D, Li J . The value of multidisciplinary team in syncope clinic for the effective diagnosis of complex syncope. Pacing Clin Electrophysiol. 2019; 42(7):821-827. DOI: 10.1111/pace.13703. View

Soteriades E, Evans J, Larson M, Chen M, Chen L, Benjamin E . Incidence and prognosis of syncope. N Engl J Med. 2002; 347(12):878-85. DOI: 10.1056/NEJMoa012407. View

10.

Taylor I, Stout R . Cardiac arrhythmias and femoral neck fracture. Age Ageing. 1983; 12(2):118-23. DOI: 10.1093/ageing/12.2.118. View

11.

Brignole M, Menozzi C, LOLLI G, Bottoni N, Gaggioli G . Long-term outcome of paced and nonpaced patients with severe carotid sinus syndrome. Am J Cardiol. 1992; 69(12):1039-43. DOI: 10.1016/0002-9149(92)90860-2. View

12.

Kapoor W, Karpf M, Wieand S, Peterson J, LEVEY G . A prospective evaluation and follow-up of patients with syncope. N Engl J Med. 1983; 309(4):197-204. DOI: 10.1056/NEJM198307283090401. View

13.

Parkkari J, Kannus P, Palvanen M, Natri A, Vainio J, Aho H . Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int. 1999; 65(3):183-7. DOI: 10.1007/s002239900679. View

14.

Morley C, Perrins E, Grant P, Chan S, McBrien D, Sutton R . Carotid sinus syncope treated by pacing. Analysis of persistent symptoms and role of atrioventricular sequential pacing. Br Heart J. 1982; 47(5):411-8. PMC: 481157. DOI: 10.1136/hrt.47.5.411. View

15.

Brenner R, Ammann P, Yoon S, Christen S, Hellermann J, Girod G . Reduction of falls and fractures after permanent pacemaker implantation in elderly patients with sinus node dysfunction. Europace. 2016; 19(7):1220-1226. DOI: 10.1093/europace/euw156. View

16.

Jacobsen S, Goldberg J, Miles T, Brody J, Stiers W, Rimm A . Race and sex differences in mortality following fracture of the hip. Am J Public Health. 1992; 82(8):1147-50. PMC: 1695748. DOI: 10.2105/ajph.82.8.1147. View

17.

Ruwald M, Hansen M, Lamberts M, Hansen C, Hojgaard M, Kober L . The relation between age, sex, comorbidity, and pharmacotherapy and the risk of syncope: a Danish nationwide study. Europace. 2012; 14(10):1506-14. DOI: 10.1093/europace/eus154. View

18.

Rubenstein L, Josephson K . The epidemiology of falls and syncope. Clin Geriatr Med. 2002; 18(2):141-58. DOI: 10.1016/s0749-0690(02)00002-2. View

19.

Krogager M, Torp-Pedersen C, Mortensen R, Kober L, Gislason G, Sogaard P . Short-term mortality risk of serum potassium levels in hypertension: a retrospective analysis of nationwide registry data. Eur Heart J. 2017; 38(2):104-112. DOI: 10.1093/eurheartj/ehw129. View

20.

Kenny R, Richardson D, Steen N, Bexton R, Shaw F, Bond J . Carotid sinus syndrome: a modifiable risk factor for nonaccidental falls in older adults (SAFE PACE). J Am Coll Cardiol. 2001; 38(5):1491-6. DOI: 10.1016/s0735-1097(01)01537-6. View