Journal of NeuroEngineering and Rehabilitation

RESEARCH Open Access The risk of major cardiovascular events for adults with transfemoral amputation Benjamin F. Mundell 1* , Marianne T. Luetmer 2 , Hilal Maradit Kremers 3,4 , Sue Visscher 5 , Kurtis M. Hoppe 2 and Kenton R. Kaufman 3 From Second World Congress hosted by the American Orthotic & Prosthetic Association (AOPA) Las Vegas, NV, USA. 06-09 September 2017 Abstract Background: It is well-known that the risk of cardiac disease is increased for those with lower-limb amputations, likely as a result of the etiology of the amputation. Using a longitudinal population-based dataset, we examined the association between transfemoral amputation (TFA) status and the risk of experiencing a major cardiac event for those undergoing either dysvascular or traumatic amputations. The association of receiving a prosthesis with the risk of experiencing a major cardiac event was also examined. Methods: Study Population : All individuals with TFA (N 162), i.e. knee disarticulation and transfemoral amputation, residing in Olmsted County, MN, between 1987 and 2014. Each was matched (1:10 ratio) with non-TFA adults on age, sex, and duration of residency. Data Analysis : A competing risk Cox proportional hazard model was used to estimate the relative likelihood of an individual with a TFA experiencing a major cardiac event in a given time period as compared to the matched controls. The cohort was divided by amputation etiology: dysvascular vs trauma/cancer. Additional analysis was performed by combining all individuals with a TFA to look at the relationship between prosthesis receipt and major cardiac events. Results: Individuals with a dysvascular TFA had an approximately four-fold increased risk of a cardiac event after undergoing an amputation (HR 3.78, 95%CI: 3.07 – 4.49). These individuals also had an increased risk for non-cardiac mortality (HR 6.27, 95%CI: 6.11 – 6.58). The risk of a cardiac event was no higher for those with a trauma/cancer TFA relative to the able-bodied controls (HR 1.30, 95%CI: 0.30 – 5.85). Finally, there was no difference in risk of experiencing a cardiac event for those with or without prosthesis (HR 1.20, 95%CI: 0.55 – 2.62). Conclusion: The high risk of initial mortality stemming from an amputation event may preclude many amputees from cardiovascular disease progression. Amputation etiology is also an important factor: cardiac events appear to be more likely among patients with a dysvascular TFA. Providing a prosthesis does not appear to be associated with a reduced risk of a major cardiac event following amputation. Keywords: Transfemoral amputation, Major cardiac event, Competing risk survival analysis * Correspondence: mundell.benjamin@mayo.edu 1 Mayo Clinic School of Medicine, Mayo Clinic, Rochester, MN, USA Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ) , which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated. Mundell et al. Journal of NeuroEngineering and Rehabilitation 2018, 15 (Suppl 1):58 https://doi.org/10.1186/s12984-018-0400-0