Crash Risk After Heart Device Implant Still Hard to Predict
Models using driving and health data to predict 1-year crash risk after the implantation of a cardioverter-defibrillator showed poor discrimination between individuals who crashed motor vehicles and those who did not. However, such models with good calibration may help guide discussions about crash risk between clinicians and patients.
METHODOLOGY:
Clinical guidelines recommend temporarily ceasing driving after the implantation of a cardioverter-defibrillator; however, these restrictions can result in social isolation or loss of income. Empirical data to inform such driving restrictions are limited.
Researchers in Canada used population-based administrative data and identified licensed drivers who had a first implantation of a cardioverter-defibrillator between 1998 and 2018 to estimate the subsequent risk for a motor vehicle crash using prediction models.
The recipients were stratified into two cohorts according to the indication for their implants: those receiving implants for primary prevention of sudden cardiac death (n = 3652; median age, 66 years; 18% women) and those receiving implants for secondary prevention (n = 3408; median age, 65 years; 16% women).
The outcome of interest was the involvement of the implant recipient as a driver in one or more crashes within the first year after the implantation procedure; crashes considered were those attended by police and/or involving an insurance claim.
TAKEAWAY:
Overall, 352 drivers (9.6%) in the primary prevention cohort and 270 drivers (7.9%) in the secondary prevention cohort were involved in crashes within the first year after implantation.
The crash prediction models poorly distinguished between individuals who crashed and those who did not in both the primary and secondary prevention cohorts (c-statistics, 0.60 and 0.61, respectively).
However, the models showed good calibration for both cohorts (calibration slopes, 1.14 and 1.07, respectively), suggesting that the models could be helpful in guiding discussions between clinicians and patients.
In the primary prevention cohort, the top predictors of crash were male sex, number of crashes in the past year, and active vehicle insurance in the past year; in the secondary prevention cohort, the predictors were male sex, no history of seizure, active opioid prescriptions, and active vehicle insurance in the past year.
IN PRACTICE:
"Clinicians already use clinical intuition and common sense to identify patients at higher risk of SCI [sudden cardiac incapacitation] , reserving their most strident advice to avoid driving for the individuals they consider to be at highest risk," the researchers noted.
"Using baseline health and driving data to formally predict post-implantation crash risk and personalize driving restrictions is a strategy that has the potential to strengthen this clinical practice, but our findings suggest this approach is not yet ready to deploy in clinical practice," they added.
SOURCE:
This study was led by John A. Staples of the University of British Columbia in Vancouver, British Columbia, Canada. It was published online on June 24, 2025, in Heart.
LIMITATIONS:
This study lacked a direct measure of road exposure, which may have affected the model performance. Data regarding several parameters, including the indication for implantation, were missing at several occasions. The researchers were unable to identify the crashes specifically caused by sudden cardiac incapacitation.
DISCLOSURES:
This study received a grant from the Heart and Stroke Foundation of Canada. One author reported receiving a Mentored Clinician Scientist Award from Vancouver Coastal Health Research Institute and a Health Professional-Investigator Award from Michael Smith Health Research BC. Another author reported receiving support from Michael Smith Health Research BC and the British Columbia Emergency Medicine Network.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Forbes
an hour ago
- Forbes
This Supreme Court Health Insurance Ruling Affects 150 Million Americans—What This Means for Cancer Patients
Editorial Note: We earn a commission from partner links on Forbes Advisor. Commissions do not affect our editors' opinions or evaluations. In a critical victory for patients on June 27th, the Supreme Court has determined that health insurance plans under the Affordable Care Act (ACA), also known as Obamacare, must continue to fully cover preventative services, including cancer screenings, HIV prevention medication, and mental health counseling, without co-pays or deductibles. An estimated 150 million Americans will benefit from the ruling, according to the O'Neill Institute at Georgetown Law. These preventative treatments have been available to Americans under the ACA since the law went into effect over a decade ago—and advocates argued that eliminating access could pose significant health care risks to those who rely on them the most. Before the ruling, a New Orleans lower court had deemed the ACA's preventative services mandate unconstitutional, arguing that the members of the U.S. Preventive Services Task Force were not validly appointed. Had the decision stood, insurers could impose cost-sharing on screenings, meaning patients could have been forced to pay hundreds or thousands of dollars in out-of-pocket costs, potentially leading to skipped exams and life-threatening delayed diagnoses. A 2024 report published in Health Services Research revealed that with the implementation of ACA, patients receiving cancer treatment increased by 6.2%, with a noted sharp increase in 2016 when Medicaid expansion took effect in Pennsylvania. Another progress report by the American Association for Cancer Research found that the ACA shrunk other coverage gaps, including the rate of delayed surgery, which dropped from 9.8% to 8.4% after Medicaid expansion for patients belonging to ethnic minority groups. Although this ruling heavily impacts cancer screenings, it also preserves coverage for other preventative care like cholesterol, blood pressure checks, lung cancer screenings, HIV prevention (PrEP), medications to prevent breast cancer, and immunizations. Patients who face multiple health risks should use a holistic approach and capitalize on ACA's benefits for a robust safety net. Consumers should: Maintain regular screenings: The Affordable Care Act continues to fully cover routine cancer screenings at no cost. Make use of annual mammograms, colonoscopies, or lung-cancer risk to catch anything at an early stage. The Affordable Care Act continues to fully cover routine cancer screenings at no cost. Make use of annual mammograms, colonoscopies, or lung-cancer risk to catch anything at an early stage. Watch for policy changes: Though coverage remains solid for now, future reforms or appointee decisions under Robert F. Kennedy Jr., Secretary of Health and Human Services, could mean changes in the future. Stay alert to federal health updates. The Supreme Court's ruling is a significant win for cancer patients and public health. By guaranteeing continued access to free preventative care, it helps improve early detection, reduce treatment costs and barriers, and save lives. However, vigilance is key. Patients should stay aware of administrative changes that might shift the policy basis of covered services in the future.
Medscape
an hour ago
- Medscape
Fast Five Quiz: The Psychosocial Burden of Psoriasis
The relationship between psoriasis and psychosocial symptoms tends to be a cyclical one. Psychological stressors can exacerbate the disease through overactivation of the hypothalamic-pituitary-adrenal axis and increased release of pro-inflammatory cytokines. Conversely, the cutaneous inflammatory response can cause body disfigurement, stigmatization, and ultimately anxiety and depression. What do you know about the psychosocial burden of psoriasis? Test your knowledge with this quick quiz. As patients with psoriasis experience a relapsing course, over time they often face a lower quality of life owing to their symptoms, social stigmas, and impacted self-esteem. For example, a review that evaluated the psychological comorbidities associated with this condition reported that patients with psoriasis who have visible psoriatic lesions face a significant negative impact on their quality of life. Further, Dermatology Life Quality Index (DLQI) and Health-Related Quality of Life (HRQOL) scores can be influenced by both lesion location and severity; increased Psoriasis Area and Severity Index scores have been linked to higher DLQI scores as well, which indicates that "as disease severity worsens, so does the overall impact on quality of life." Patients can experience any form of psychological and social distress as a result, not just anxiety. Although depression in psoriasis is common, the psychosocial impact of the disease has not been mainly linked with fear of developing psoriatic arthritis. Learn more about the prognosis of psoriasis. In patients with psoriasis, female sex has been identified as a risk factor for depression in this population. A systematic review exploring the burden of depression in psoriasis reported a higher overall prevalence of depression in females over males. This is consistent with other recent data; however, male patients with psoriasis still seem to have an increased prevalence of depression compared with males without psoriasis. Ultimately, current data point to the fact that the prevalence of depression is higher among all patients with psoriasis, but female patients with skin disease appear to be at greater risk than their male counterparts. Younger age is more frequently associated with depression, though older individuals with psoriasis can still be affected. Learn more about the prognosis of psoriasis. Pruritus is one of the main symptoms of plaque psoriasis. Although it varies in intensity, this symptom should not be disregarded owing to its significant impact on mental health. Anxiety and depression are linked to plaque psoriasis; these psychological comorbidities can increase the frequency and severity of pruritus, which results in an increased tendency to scratch; conversely, the increased pruritus and scratching also worsens anxiety and depression. It is estimated that 40% of patients with plaque psoriasis experience nail involvement. Further, nail involvement has been linked to "significant psychological distress, including anxiety and depression." Though any severity of skin pain can be linked to psychosocial burden in patients with chronic dermatological disorders such as plaque psoriasis, data have shown that patient-reported skin pain is usually of "moderate intensity" when HRQOL is negatively affected. Learn more about the signs and symptoms of plaque psoriasis. Psychosocial interventions have been shown to improve DLQI scores in patients with psoriasis. Specifically, the addition of mindfulness therapy to treatment as usual for psoriasis has been found to improve DLQI the most compared with other studied interventions (treatment as usual alone, psoriasis and lifestyle education, and online-based management). Cognitive-behavioral therapy in conjunction with pharmacological therapy has also been shown to improve psychosocial and disease-related symptoms. This result is most likely owing to stress as an identified trigger for psoriasis flares and decreased DLQI scores, with mindfulness therapy aiming to reduce stress and therefore flares. This is consistent with another recent review finding improvement in both disease severity and DLQI scores with various forms of mindfulness intervention. However, cognitive-behavioral therapy and treatment as usual were most effective for the other outcome measures, including anxiety, depression, and treatment adherence; mindfulness therapy was the least effective intervention for adherence. Education regarding psoriasis and lifestyle management that can help with symptoms was shown to improve HRQOL. Learn more about the treatment of psoriasis. Biologic therapy has been shown to effectively treat depression symptoms in the setting of psoriasis. Other therapeutic approaches that are effective for depression symptoms in psoriasis were conventional systemic therapy and phototherapy. Taken together, evidence supports the theory that improved skin disease is associated with improved psychiatric disease. Patients with psoriasis have a higher prevalence of hypertension. Beta-blockers in this setting can worsen psoriasis, which can negatively affect depression symptoms. Overall, evidence of a link between depression symptoms and beta-blocker use is mixed. Some psychotropic medications can cause flares in skin disease, including lithium, fluoxetine, and bupropion; these agents should therefore be prescribed with caution in this population. Similarly, the link between depression symptoms and psychotropic medication use is inconsistent. Though certain phosphodiesterase 4 inhibitors can improve psoriasis symptoms and can improve quality of life, data indicate that they can worsen depression symptoms. Learn more about the treatment of psoriasis. Editor's Note: This article was created using several editorial tools, including generative AI models, as part of the process. Human review and editing of this content were performed prior to publication.
CBS News
an hour ago
- CBS News
All Illinois children will have to be tested for lead exposure in 2026
By this time next year, all children in Illinois will have lead exposure testing as the state expands the zip codes considered high risk. The state is adding 180 more zip codes where led exposure testing will be required, part of a push for universal statewide lead exposure testing. Under state law, every child must be tested for lead exposure at 1 and 2 years old starting in 2026. All kids aged 6 and younger must also be asked about exposure by a health care provider. The expansion comes as Cook County home health care service Lead Care celebrated replacing 200 lead service lines in the county for free, giving hundreds of childcare facilities in the suburbs access to safe drinking water. Cook County communities have some of the highest number of lead service lines in the U.S. Lead exposure poses a serious health risk to children under 6.
