Abstract

This study examined if deaths from sudden cardiac arrest might fall if automated external defibrillators (AED) were available within the home. Use of AEDs in the home did not reduce the overall death rate in patients with heart conditions. While there is minimal hazard to patients and loved ones for inappropriate use, a home-based AED strategy is not the best use of scarce health care resources. Background: This study examined if deaths from sudden cardiac arrest could be reduced through the use of automated external defibrillators (AED) in the home of patients.

Methods: A large multinational study involving 7001 patients with heart disease was completed. In the AED group, participants and their families received training and an AED unit for use within the home. Participants and their families in the control group received training on CPR and were instructed to call for emergency assistance. Participants were followed for over two years (average of 37 months).

Findings: During the study period, 450 people died of all causes, 228 deaths in the control and 222 in the AED group. Even after adjusting for age, sex, and type of heart attack, the AED did not make a difference in the overall death rate, except for those patients with diabetes who showed a slight improvement. Use of the AED by family members was found to be safe and applied appropriately.

The use of AED on neighbours or visitors who had a heart attack were also considered. Of the seven cases, shock was administered to four individuals. Of these four, two individuals were saved and the three who did not receive AED shock all died.

Conclusions: Use of AEDs in the home did not reduce the overall death rate in patients with mild heart conditions. While there is minimal hazard to patients and loved ones for inappropriate use, a home-based AED strategy is not the best use of scarce resources. Using AEDs is more effective when targeted at higherrisk populations or in public venues like shopping malls, community centres, or airports. Additional investment in AEDs by governments should be targeted to public venues to maximize the likelihood of benefit.

References

Bardy GH, Lee KL, Mark DB, Poole JE, Toff WD, Tonkin AM, Smith W, Dorian P, Packer DL, White RD, Longstreth WT, Anderson J, Johnson G, Bischoff E, Yallop JJ, McNulty S, Ray LD, Clapp-Channing NE, Rosenberg Y, Schron EB. "Home Use of Automated External Defibrillators for Sudden Cardiac Arrest". The New England Journal of Medicine, 2008; 358, 1793-1804.