Mayo Clinic study: 20 percent of patients are prescribed opioids after cardiac device implantation surgery

This large US study found that one in five patients was prescribed opioids after having a pacemaker or similar device implanted and 80 percent had never taken opioids before, report investigators in HeartRhythm


Philadelphia, October 21, 2019

One in five patients is prescribed opioids after having a pacemaker or similar device implanted, according to a large US study conducted at Mayo Clinic and published in HeartRhythm, the official journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, published by Elsevier. Eighty percent of patients who were prescribed opioids had never taken them before. Investigators stress the importance of improving postoperative pain management following cardiac device procedures to reduce use of prescription opioids.

Prescription opioids are a major contributor to the opioid epidemic in the US and are linked to prescription opioid abuse, addiction, and deaths due to overdose. More people now die due to prescription opioid overdose than from cocaine and heroin.

“Opioid prescription following cardiac implantable electronic device procedures (CIED) has not previously been studied,” explained lead investigator Siva K. Mulpuru, MD, Mayo Clinic Rochester, Rochester, MN, USA. “The main aim of our study was therefore to gain a better understanding of opioid prescription patterns following CIED procedures. Secondary objectives were to understand various factors associated with opioid prescriptions and to evaluate continued opioid prescription rates (refills) after initial surgery.”

Investigators performed a retrospective cohort study of all patients undergoing device procedures including implantation of pacemakers, cardioverter defibrillators, generator changes, and lead extractions at the Mayo Clinic Enterprise Heart Rhythm Practice. The study included patients at the three academic campuses in Rochester, MN; Phoenix, AZ; and Jacksonville, FL. More than 16,500 adult patients who underwent CIED procedures and were discharged between January 1, 2010 and March 30, 2018 were included in the study. Procedures were categorized into new implant, generator change, device upgrade, lead revision or replacement, and subcutaneous implantable cardiac defibrillator (S-ICD) procedures. The investigators assessed how frequently opioids were prescribed after the procedure, and how frequently patients who were prescribed opioids continued to refill their opioid prescriptions.

Opioids were prescribed to about 20 percent of the patients of whom 80 percent were “opioid naïve” (e.g., they had never taken opioids before). Among the opioid naïve patients who received opioids, more than nine percent subsequently refilled their prescription. Close to 40 percent of these patients received more than 200 oral morphine equivalents on prescription. The investigators concluded that several factors influence the decision to prescribe opioids, such as the healthcare provider’s pain management training and prior experiences; patients’ expectations of pain control; underlying comorbidities; and personal sensitivity to pain.

Figure shows the conceptual framework of opioid prescriptions.

This figure shows the conceptual framework of opioid prescriptions. Provider attitudes about pain control may be influenced by pain management training and prior experiences. Patient factors, such as expectations of pain control, underlying comorbidities, and personal sensitivity to pain, are intertwined with the social norms about pain control and the perceived healthcare provider’s ability to control pain. All these factors influence the provider's decision to prescribe opioids. Depending on the ease of prescribing, this may ultimately lead to the prescription of opioids. Credit: Mayo Foundation for Medical Education and Research.

"The explanation for this high number of opioid prescriptions could be due to various reasons including provider factors, patient factors, and social norms,” noted first author Justin Z. Lee, MD, Mayo Clinic, Rochester, MN, USA. “We need to focus more on alternative pain management strategies to reduce the use of opioids after device procedures."

"There is a clear need for more studies and awareness of perioperative pain management after device procedures to reduce postoperative pain and postoperative opioid prescriptions,” added co-author Abhishek Deshmukh, MBBS, Mayo Clinic, Rochester, MN, USA. “This ranges from various intraprocedural techniques to reduce postoperative pain to considerations of using a combination of scheduled nonopioid medications for a better nonopioid pain control strategy."

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Notes for editors
The article is “Postoperative opioid prescription patterns and new opioid refills following cardiac implantable electronic device procedures,” by Justin Z. Lee, MD, Ahmed K. Pasha, MD, Amy E. Glasgow, MHA, Elizabeth B. Habermann, PhD, MPH, Fred M. Kusumoto, MD, FHRS, Christopher J. McLeod, MBChB, PhD, FHRS, Vasudha Goel, MD, Dan Sorajja, MD, Komandoor Srivathsan, MD, Win-Kuang Shen, MD, FHRS, Malini Madhavan, MBBS, Abhishek J. Deshmukh, MBBS, Yong-Mei Cha, MD, FHRS, Paul A. Friedman, MD, FHRS, Samuel J. Asirvatham, MD, FHRS, and Siva K. Mulpuru, MD, FHRS ( https://doi.org/10.1016/j.hrthm.2019.08.011 ). It appears in HeartRhythm, volume 16, issue 12 (December 2019) published by Elsevier.

Full text of this article is available to credentialed journalists upon request; contact Jane Grochowski at +1 406 542 8397 or hmsmedia@elsevier.com. Journalists who wish to interview the authors should contact Justin Z. Lee at Lee.Justin1@mayo.edu.

About HeartRhythm
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. It integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. www.heartrhythmjournal.com

About the Heart Rhythm Society
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal healthcare policies and standards. The Heart Rhythm Society is the preeminent professional group representing more than 5,100 specialists in cardiac pacing and electrophysiology from more than 70 countries. www.HRSonline.org

About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers. www.elsevier.com

Media contact
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+1 406 542 8397
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