Traumatic injury and atrial fibrillation among deployed service members

Abstract

Introduction Atrial fibrillation and atrial flutter (AF/AFL), the most common atrial arrhythmias, have never been examined in combat casualties. In this study, we investigated the impact of traumatic injury on AF/AFL among service members with deployment history. Methods Sampled from the Department of Defense (DoD) Trauma Registry (n = 10,000), each injured patient in this retrospective cohort study was matched with a non‐injured service member drawn from the Veterans Affairs/DoD Identity Repository. The primary outcome was AF/AFL diagnosis identified using ICD‐9‐CM and ICD‐10‐CM codes. Competing risk regressions based on Fine and Gray subdistribution hazards model with were utilized to assess the association between injury and AF/AFL. Results There were 130 reported AF/AFL cases, 90 of whom were injured and 40 were non‐injured. The estimated cumulative incidence rates of AF/AFL for injured was higher compared to non‐injured patients (hazards ratio [HR] = 2.04; 95% confidence interval [CI] = 1.44, 2.87). After adjustment demographics and tobacco use, the association did not appreciably decrease (HR = 1.90; 95% CI = 1.23, 2.93). Additional adjustment for obesity, hypertension, diabetes, and vascular disorders, the association between injury and AF/AFL was no longer statistically significant (HR = 1.51; 95% CI = 0.99, 2.52). Conclusion Higher AF/AFL incidence rate was observed among deployed service members with combat injury compared to servicemembers without injury. The association did not remain significant after adjustment for cardiovascular‐related covariates. These findings highlight the need for combat casualty surveillance to further understand the AF/AFL risk within the military population and to elucidate the potential underlying pathophysiologic mechanisms.

Suicide attempts and mental health diagnoses in combat‐injured service members: A retrospective cohort study

“…Protocols for this study were reviewed and approved by the David Grant USAF Medical Center Institutional Review Board (IRB), the University of Utah IRB, and the Research Review Committee of the VA Salt Lake City Health Care System. As previously described (Alcover et al, 2021; Haynes, Collen, et al, 2021; Stewart et al, 2020; Walker et al, 2021; Haynes, Stewart, et al, 2021), we utilized DoD and VA healthcare systems datasets to establish two matched cohorts of service members, one with and one without record of injury in the DoD Trauma Registry (DoDTR). The DoDTR contains injury, treatment, outcome, and demographic data for injured service members admitted to a surgical field hospital, or Role 3 facility (Joint Trauma System, n.d.).…”