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Lorenzo Ruiz I. Longevity and potential reusability of cardiac implantable electronic devices explanted in funeral homes. Pacing Clin Electrophysiol 2023. [PMID: 37114760 DOI: 10.1111/pace.14703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/25/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND While in high-income countries (HICs) the implantation of cardiac implantable electronic devices (CIEDs) is common, in certain low- and middle-income countries (LMICs) access to devices is limited and insufficient to meet the demand. Between 17% and 30% of CIEDs explanted post-mortem in HICs appears to have enough battery life to be reused but devices are not routinely programmed to no pacing output and continue to consume battery after the patient's death. Therefore, we conducted a prospective analysis of CIEDs collected from funeral homes, controlling variables such as the date of explantation and limiting the time until the date of interrogation to 6 months. The objective was to perform an accurate analysis of the reusability of post-mortem explanted CIEDs to assess the possibility of implementing a local effort of CIED reuse in LMICs. METHODS A descriptive study of post-mortem explanted CIEDs in funeral homes was conducted. Participating centers stored all devices explanted between December 2020 to December 2021 for collection and interrogation. RESULTS The participating centers attended 6472 deaths (28.05% of total deaths registered in the region). Two hundred fourteen CIEDs were collected (90.2% pacemakers and 9.8% defibrillators). Of the 214 collected devices, 100 CIEDs (46.7%) had >4 years or >75% battery remaining, preserved external integrity, and no evidence of malfunction and therefore were considered reusable. CONCLUSIONS Based on stablished criteria 46.7% of recovered devices were considered reusable. Therefore, recovery from funeral homes of HICs comprises a potential source of reusable devices for LMICs.
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Affiliation(s)
- Iñigo Lorenzo Ruiz
- Nursing Department, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU,Sarriena, Leioa, Spain
- BioCruces-Bizkaia Health Research Institute, Barakaldo, Spain
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Lima NDA, Rocha EA, Damasceno A, Costa IP, Ricardo JRB, Lopes FJ, Dias L, Soares MBDPC, Puroll E, Eagle KA, Crawford TC. Pacemaker Reuse in Portuguese Speaking Countries: A Clinical Reflection. Arq Bras Cardiol 2023; 120:e20210941. [PMID: 36921183 DOI: 10.36660/abc.20210941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 09/01/2022] [Indexed: 03/06/2023] Open
Abstract
There is a gap between high-income countries and others in terms of access to medical cardiac devices, such as pacemakers and implantable cardioverter defibrillators. Costs are one of the main barriers to the use of cardiac devices in these countries. There are international initiatives that aim to reduce the gap. The reuse of pacemakers has been discussed as a possible alternative to this problem. The concept of reusing pacemakers is not new; however, recent studies have proven to be safe, ethical, and effective for those who need cardiac implantable electronic devices and cannot afford them. Part of the Portuguese-speaking countries, especially in Africa, need an immediate response that benefits their countless patients who suffer from treatable arrhythmias.
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Affiliation(s)
| | - Eduardo Arrais Rocha
- Universidade Federal do Ceará - Hospital Universitário Walter Cantídio - Programa de Pós-graduação em Ciências Cardiovasculares da Faculdade de Medicina da UFC, Fortaleza, CE - Brasil
| | | | - Ieda Prata Costa
- Universidade Federal do Ceará - Hospital Universitário Walter Cantídio - Programa de Pós-graduação em Ciências Cardiovasculares da Faculdade de Medicina da UFC, Fortaleza, CE - Brasil
| | | | | | - Luis Dias
- Hospital Agostinho Neto, Praia - Cabo Verde
| | | | - Eric Puroll
- University of Michigan Medicine, Ann Arbor, Michigan - EUA
| | - Kim A Eagle
- University of Michigan Medicine - Frankel Cardiovascular Center, Ann Arbor, Michigan - EUA
| | - Thomas C Crawford
- University of Michigan Medicine - Frankel Cardiovascular Center, Ann Arbor, Michigan - EUA
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Advancing global equity in cardiac care as cardiac implantable electronic device reuse comes of age. Heart Rhythm O2 2022; 3:799-806. [PMID: 36589002 PMCID: PMC9795283 DOI: 10.1016/j.hroo.2022.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
A nation's health and economic development are inextricably and synergistically connected. Stark differences exist between wealthy and developing nations in the use of cardiac implantable electronic devices (CIEDs). Cardiovascular disease is now the leading cause of death in low- and middle-income countries (LMIC), with a significant burden from rhythm-related diseases. As science, technology, education, and regulatory frameworks have improved, CIED recycling for exportation and reuse in LMIC has become possible and primed for widespread adoption. In our manuscript, we outline the science and regulatory pathways regarding CIED reuse. We propose a pathway to advance this technology that includes creating a task force to establish standards for CIED reuse, leveraging professional organizations in areas of need to foster the professional skills for CIED reuse, collaborating with regulatory agencies to create more efficient regulatory expectations and bring the concept to scale, and establishing a global CIED reuse registry for quality assurance and future science.
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Lorenzo Ruiz I, Arrizabalaga Arostegi H, Fernández Atucha A. Battery life of cardiac implantable electronic devices explanted in funeral homes: a potential resource for underserved nations. Expert Rev Med Devices 2022; 19:733-737. [PMID: 36171720 DOI: 10.1080/17434440.2022.2130757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Cardiac implantable electronic devices (CIEDs) could still have adequate battery life and functionality when they are explanted after the death of the carrier, supposing an important resource for low- and middle- income countries where patients cannot afford new devices. OBJECTIVE The aim was to analyse the remaining battery life and reusability of CIEDs recovered from funeral homes. METHOD A descriptive study of postmortem explanted CIEDs was conducted. Devices were collected from three funeral homes in the Spanish region of the Basque Country (participation rate 33.3%). Devices with a remaining battery life of >75% or > 4 years, preserved external integrity and no evidence of malfunction were considered reusable. RESULTS A total of 188 CIEDs were collected (175 pacemakers and 13 defibrillators). Of the total number of devices, 95 (50.5%) had enough battery to be interrogated. Among the interrogable devices, a total of 20 pacemakers (22.4%) had an estimated battery life of more than 4 years, as well as preserved integrity and no record of malfunction. CONCLUSIONS A non-negligible number of postmortem explanted devices had battery life, external integrity and functionality to be considered reusable. Postmortem CIED donation could provide treatment to patients unable to afford new devices.
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Affiliation(s)
- Iñigo Lorenzo Ruiz
- Nursing department I, Faculty of Medicine and Nursing, University of the Basque Country, UPV/EHU, Leioa, Spain.,BioCruces-Bizkaia Health Research Institute. Barakaldo, Spain
| | | | - Ainhoa Fernández Atucha
- Nursing department I, Faculty of Medicine and Nursing, University of the Basque Country, UPV/EHU, Leioa, Spain
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Crawford TC, Eagle KA. Reuse of catheters and devices labelled for single use: evidence, recommendations and oversight. HEART ASIA 2018; 10:e011033. [PMID: 30556816 DOI: 10.1136/heartasia-2018-011033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Thomas C Crawford
- Department of Internal Medicine, Division of Cardiovascular Disease, The University of Michigan, Ann Arbor, Michigan, USA
| | - Kim A Eagle
- Department of Internal Medicine, Division of Cardiovascular Disease, The University of Michigan, Ann Arbor, Michigan, USA
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Global disparities in cardiac pacemaker therapy: Problem statement, potential solution, and call to action. Heart Rhythm 2018; 16:153-155. [PMID: 30321716 DOI: 10.1016/j.hrthm.2018.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Indexed: 11/23/2022]
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Mahesh M, Sharma M, Mascarenhas DA. A Community Level Sample Survey to Determine CurrentUnderstanding About Medical Recycling of Cardiovascular ImplantableElectronic Devices. Cardiol Res 2018; 9:239-243. [PMID: 30116452 PMCID: PMC6089467 DOI: 10.14740/cr755w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 07/20/2018] [Indexed: 11/11/2022] Open
Abstract
Background Medical recycling and reutilization of cardiovascular implantableelectronic devices (CIEDs) have a significant impact not only in patientsof low-income countries but may also in certain patients in the UnitedStates who do not have sufficient medical insurance coverage. Themain determining factor for future utility and popularity of recycledmedical devices is thorough understanding about this topic amongstpublic and healthcare professional. To the best of our knowledge,there has been no study conducted so far at a community level to determinethe understanding in public and healthcare personnel about recyclingof medical devices including CIEDs. We sought to determine existingknowledge and attitude about recycling of CIEDs amongst representativesample population in a community. Methods A questionnaire was sent for online completion to multiple peoplein the community, healthcare and funeral home in Lehigh Valley, Pennsylvania,USA. The questionnaire was designed in order to assess three maincategories; knowledge, attitude and practice. We called this a KAPstudy which is an acronym for knowledge, attitude and practice survey. Results We got 117 responses to our questionnaire from community members(55.45%), 89 responses (42.18%) from the healthcare personnel andfive responses (2.37%) from funeral homes. About 30.77% communityparticipants had heard about medical devices recycling compared to57.30% participants from healthcare sector. A total of 88.64% of medicalprofessionals were aware that there are people in the world who diebecause they cannot afford CIEDs while 73.50% of community participantswere also found to be aware of this fact. Higher percentages of healthcareprofessionals were found to be willing to personally consider a decisionabout medical device donation compared to community participants. Conclusions CIED reutilization can improve quality of life among many patientswith low or medium socioeconomic status. People should be made moreaware about the benefits of CIED reutilization. Concerns about device-relatedinfections, complications and law suits should be addressed to helpimprove their utility.
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Affiliation(s)
| | - Munish Sharma
- Department of Heart Failure and PulmonaryHypertension, Hackensack University Medical Center, Hackensack, NJ,USA
| | - Daniel An Mascarenhas
- Drexel University College of Medicine,Philadelphia, PA 19129, USA.,Easton Hospital, Easton, PA 18042, USA
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Crawford TC, Allmendinger C, Snell J, Weatherwax K, Lavan B, Baman TS, Sovitch P, Alyesh D, Carrigan T, Klugman N, Kune D, Hughey A, Lautenbach D, Sovitch N, Tandon K, Samson G, Newman C, Davis S, Brown A, Wasserman B, Goldman E, Arlinghaus SL, Oral H, Eagle KA. Cleaning and Sterilization of Used Cardiac Implantable Electronic Devices With Process Validation. JACC Clin Electrophysiol 2017; 3:623-631. [DOI: 10.1016/j.jacep.2016.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 11/29/2016] [Accepted: 12/01/2016] [Indexed: 11/30/2022]
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Runge MW, Baman TS, Davis S, Weatherwax K, Goldman E, Eagle KA, Crawford TC. Pacemaker recycling: A notion whose time has come. World J Cardiol 2017; 9:296-303. [PMID: 28515847 PMCID: PMC5411963 DOI: 10.4330/wjc.v9.i4.296] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 02/24/2017] [Accepted: 03/12/2017] [Indexed: 02/06/2023] Open
Abstract
The purpose of this paper is to summarize the need, feasibility, safety, legality, and ethical perspectives of pacemaker reutilization in low- and middle-income countries (LMICs). It will also describe, in-depth, Project My Heart Your Heart (PMHYH) as a model for pacemaker reuse in LMICs. The primary source of the discussion points in this paper is a collection of 14 publications produced by the research team at the University of Michigan and its collaborative partners. The need for pacemaker reutilization in LMICs is evident. Numerous studies show that the concept of pacemaker reutilization in LMICs is feasible. Infection and device malfunction are the main concerns in regard to pacemaker reutilization, yet many studies have shown that pacemaker reuse is not associated with increased infection risk or higher mortality compared with new device implantation. Under the right circumstances, the ethical and legal bases for pacemaker reutilization are supported. PMHYH is a proof of concept pacemaker donation initiative that has allowed funeral home and crematory directors to send explanted devices to an academic center for evaluation and re-sterilization before donation to underserved patients in LMICs. The time is now to pursue large-scale studies and trials of pacemaker reuse for the betterment of society. PMHYH is leading the way in the effort and is poised to conduct a prospective randomized, non-inferiority, multicenter study to confirm the clinical efficacy and safety of pacemaker reuse, for clinical and legal support.
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Affiliation(s)
- Mason W Runge
- Mason W Runge, Kim A Eagle, Thomas C Crawford, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, United States
| | - Timir S Baman
- Mason W Runge, Kim A Eagle, Thomas C Crawford, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, United States
| | - Sheldon Davis
- Mason W Runge, Kim A Eagle, Thomas C Crawford, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, United States
| | - Kevin Weatherwax
- Mason W Runge, Kim A Eagle, Thomas C Crawford, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, United States
| | - Ed Goldman
- Mason W Runge, Kim A Eagle, Thomas C Crawford, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, United States
| | - Kim A Eagle
- Mason W Runge, Kim A Eagle, Thomas C Crawford, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, United States
| | - Thomas C Crawford
- Mason W Runge, Kim A Eagle, Thomas C Crawford, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, United States
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Jama ZV, Chin A, Badri M, Mayosi BM. Performance of re-used pacemakers and implantable cardioverter defibrillators compared with new devices at Groote Schuur Hospital in Cape Town, South Africa. Cardiovasc J Afr 2015; 26:181-7. [PMID: 26407220 PMCID: PMC4683290 DOI: 10.5830/cvja-2015-048] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/12/2015] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Little is known about the performance of re-used pacemakers and implantable cardioverter defibrillators (ICDs) in Africa. We sought to compare the risk of infection and the rate of malfunction of re-used pacemakers and ICDs with new devices implanted at Groote Schuur Hospital in Cape Town, South Africa. METHODS This was a retrospective case comparison study of the performance of re-used pacemakers and ICDs in comparison with new devices implanted at Groote Schuur Hospital over a 10-year period. The outcomes were incidence of device infection, device malfunction, early battery depletion, and device removal due to infection, malfunction, or early battery depletion. RESULTS Data for 126 devices implanted in 126 patients between 2003 and 2013 were analysed, of which 102 (81%) were pacemakers (51 re-used and 51 new) and 24 (19%) were ICDs (12 re-used and 12 new). There was no device infection, malfunction, early battery depletion or device removal in either the re-used or new pacemaker groups over the median follow up of 15.1 months [interquartile range (IQR), 1.3-36.24 months] for the re-used pacemakers, and 55.8 months (IQR, 20.3-77.8 months) for the new pacemakers. In the ICD group, no device infection occurred over a median follow up of 35.9 months (IQR, 17.0-70.9 months) for the re-used ICDs and 45.7 months (IQR, 37.6-53.7 months) for the new ICDs. One device delivered inappropriate shocks, which resolved without intervention and with no harm to the patient. This re-used ICD subsequently needed generator replacement 14 months later. In both the pacemaker and ICD groups, there were no procedure-non-related infections documented for the respective follow-up periods. CONCLUSION No significant differences were found in performance between re-used and new pacemakers and ICDs with regard to infection rates, device malfunction, battery life and device removal for complications. Pacemaker and ICD re-use is feasible and safe and is a viable option for patients with bradyarrhythmias and tachyarrthythmias.
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Affiliation(s)
- Zimasa V Jama
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa.
| | - Ashley Chin
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa
| | - Motasim Badri
- College of Medicine, King Saudi Bin, Abdulaziz University for Medical Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Bongani M Mayosi
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa
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