Original Article
Home Use of Automated External Defibrillators for Sudden Cardiac Arrest
N Engl J Med 2008; 358:1793-1804April 24, 2008
- Abstract
Background
The most common location of out-of-hospital sudden cardiac arrest is the home, a situation in which emergency medical services are challenged to provide timely care. Consequently, home use of an automated external defibrillator (AED) might offer an opportunity to improve survival for patients at risk.
Methods
We randomly assigned 7001 patients with previous anterior-wall myocardial infarction who were not candidates for an implantable cardioverter–defibrillator to receive one of two responses to sudden cardiac arrest occurring at home: either the control response (calling emergency medical services and performing cardiopulmonary resuscitation [CPR]) or the use of an AED, followed by calling emergency medical services and performing CPR. The primary outcome was death from any cause.
Results
The median age of the patients was 62 years; 17% were women. The median follow-up was 37.3 months. Overall, 450 patients died: 228 of 3506 patients (6.5%) in the control group and 222 of 3495 patients (6.4%) in the AED group (hazard ratio, 0.97; 95% confidence interval, 0.81 to 1.17; P=0.77). Mortality did not differ significantly in major prespecified subgroups. Only 160 deaths (35.6%) were considered to be from sudden cardiac arrest from tachyarrhythmia. Of these deaths, 117 occurred at home; 58 at-home events were witnessed. AEDs were used in 32 patients. Of these patients, 14 received an appropriate shock, and 4 survived to hospital discharge. There were no documented inappropriate shocks.
Conclusions
For survivors of anterior-wall myocardial infarction who were not candidates for implantation of a cardioverter–defibrillator, access to a home AED did not significantly improve overall survival, as compared with reliance on conventional resuscitation methods. (ClinicalTrials.gov number, NCT00047411.)
Media in This Article
Figure 1
Kaplan–Meier Curves for Death from Any Cause.Figure 2
Hazard Ratios for Major Subgroups of Patients.Article Activity
- Article
Sudden cardiac arrest remains an unsolved public health problem, with approximately 166,200 out-of-hospital cardiac arrests occurring annually in the United States.1 The use of automated external defibrillators (AEDs) by trained lay responders in community-based public-access defibrillation programs has been shown to increase survival after sudden cardiac arrest. However, what effect the use of the device has on overall mortality for the community at risk is unknown.2-5 Particularly impressive results have been reported when sudden cardiac arrest is witnessed and an AED is immediately available, as on airplanes and in casinos and airports.6-8 However, the effect of such programs is limited, since about three quarters of sudden cardiac arrests occur in the home,9,10 where successful resuscitation is typically achieved in only 2% of cases.11
The combination of ease of use, low cost, and negligible maintenance makes home AED therapy a potentially attractive approach to a major public health problem. The purpose of the Home Automated External Defibrillator Trial (HAT) was to test whether an AED in the home of patients at intermediate risk of sudden cardiac arrest could improve survival.
Methods
Study Design
Our international, multicenter clinical trial was sponsored by the National Heart, Lung, and Blood Institute (NHLBI).12 AEDs were provided free of charge by Philips Medical Systems and Laerdal Medical as a subsidiary distributor. Both companies also provided funding for research meetings. The corporate sponsors had no role in the design of the trial, the collection or analysis of the data, the writing of the manuscript, or the decision to publish the results. The trial was approved by the institutional review board at each participating center and was performed with the oversight of an NHLBI-appointed data and safety monitoring board.
Patients
Patients whose medical condition was stable and who had had a previous anterior-wall Q-wave or non–Q-wave myocardial infarction were selected for enrollment because such patients represent a sizable group known to be at increased risk for sudden cardiac arrest.13-15 Patients were excluded from the study if they were candidates for implantable cardioverter–defibrillator therapy, according to published guidelines.16-19 Contemporary evidence-based drug therapy after myocardial infarction was encouraged for all patients. Patients were required to have a spouse or companion who was willing and able to call for assistance from emergency medical services, perform cardiopulmonary resuscitation (CPR), and use an AED. Patients with an implantable cardioverter–defibrillator, with their own AED, or with a do-not-resuscitate order were excluded. Written informed consent was provided by all patients and their spouses or companions.
Group Assignments
Patients who had received conventional training to respond to a cardiac arrest were randomly assigned in equal proportions to receive either an AED for home use or no AED. Randomization was performed with the use of permuted blocks, stratified according to clinical center.
The goal for the control group after sudden cardiac arrest was an immediate telephone request for assistance from emergency medical services and prompt initiation of CPR, in accordance with published guidelines for basic life support.20 Patients and their spouses or companions in the control group received a video, specifically scripted to educate laypersons on how to call for assistance and perform CPR.21
The goal in the AED group was to use the AED first, in accordance with published guidelines for AED use.22 The AED that was selected for this trial, the Home HeartStart (Philips), is the only device that is approved by the Food and Drug Administration for home use. Spouses or companions were instructed to call emergency medical services and perform CPR, as in the control group. However, in the AED group, spouses or companions placed the call for assistance and performed CPR after the application of the AED. If two or more rescuers were present, the call to emergency medical services was to occur simultaneously with the use of the AED. Patients in the AED group received a video that was specifically scripted to educate laypersons on how to use the AED, call for assistance, and perform CPR.21 Patients and their spouses or companions were advised to keep the AED in a prominent location in the home to facilitate ease of access and regular visual confirmation of the AED's readiness.
Training and Follow-up
In both study groups, video-based training was used to standardize instruction and facilitate refresher training at intervals of 3 months. Investigators were also encouraged to offer hands-on training at enrollment and during annual follow-up visits. A telephone call between annual visits was used to obtain information on vital status and encourage viewing of the video.
Definition and Adjudication of Outcomes
The primary outcome was death from any cause. Secondary outcomes included death from sudden cardiac arrest, survival from witnessed sudden cardiac arrest in the home, and the outcome after the use of an AED.
All deaths and sudden cardiac arrests were adjudicated with the use of prespecified criteria by a clinical events committee whose members were unaware of study-group assignments. Death was classified as being due to cardiac causes or noncardiac causes according to the most proximate cause. Cardiac arrest was defined as a sudden loss of consciousness requiring CPR or transthoracic defibrillation. Death and cardiac arrest were classified as sudden if they occurred within 1 hour after the onset of major accelerating symptoms; cardiac arrest was classified as witnessed if the patient was seen or heard within 5 minutes before collapse. Resuscitated cardiac arrest was defined as survival for more than 48 hours. In the event of use of an AED, the electrocardiographic data were retrieved whenever possible, and rhythms were categorized as ventricular fibrillation, asystole, or organized rhythm.23,24
Statistical Analysis
The trial was designed to have a power of 90% to detect a 20% reduction in the relative risk of death from any cause, with a target recruitment of 7000 patients during a 2.5-year period and a minimum follow-up of 2 years.12 We assumed an annual rate of death of 4% in the control group, a crossover rate of less than 2%, and a loss of partner or companion of less than 5%. The anticipated reduction in mortality was based on the assumption that half the number of deaths would be due to sudden cardiac arrest and that the use of an AED would reduce the rate of death from sudden cardiac arrest by 40%, with the expectation that patients would be at home and in the presence of their spouses or companions more than 50% of the time.
We performed all major study-group comparisons according to the intention-to-treat principle. All statistical tests were two-tailed. Cumulative event rates were calculated with the use of the Kaplan–Meier method.25 Event times for all patients were measured from the time of randomization. A log-rank test was used for the comparison of the AED group with the control group with respect to the primary outcome.26 Hazard ratios with associated confidence intervals were derived with the use of a Cox proportional-hazards model.27 The Cox model was also used to assess the consistency of the treatment effect by testing for interactions between treatment and prespecified baseline characteristics. The log-rank test and Cox model were also used in the assessment of study-group differences and analyses for secondary outcomes.
Five interim analyses of the data were performed and reviewed by the data and safety monitoring board. Interim comparisons between study groups used two-sided, symmetric O'Brien–Fleming boundaries that were generated with the alpha-spending-function approach to group-sequential testing.28,29
Results
Study Population
From January 23, 2003, to October 20, 2005, a total of 7001 patients underwent randomization at 178 clinical sites in seven countries; 3506 patients were assigned to the control group, and 3495 were assigned to the AED group. The patients were enrolled at centers in the United States (29.1%), Canada (27.0%), Australia (20.9%), the United Kingdom (14.6%), New Zealand (8.1%), the Netherlands (0.1%), and Germany (0.1%).
The median age of the patients was 62 years; 17.4% were women, and 12.9% were members of a racial or ethnic minority group (Table 1Table 1
Characteristics of the Patients and Their Spouses or Companions.). At baseline, all patients had an anterior-wall myocardial infarction; 64.4% had a Q-wave event, and 35.6% had a non–Q-wave event. The median interval between the date of the qualifying myocardial infarction and trial enrollment was 1.7 years.The designated rescuers were younger than the patients (median age, 58 years) and predominantly female (82.5%); most were married to the patient (87.8%) (Table 1). In 33.3% of households, there were two or more potential rescuers. A total of 42.6% of the patients and 48.8% of the spouses or companions worked either full-time or part-time. The median estimated time that patients were alone at home was 1.5 hours per day; other persons at home with the patient may or may not have included the study rescuer. The patients reported a median estimated time away from home of 4.0 hours.
Patients were followed through September 30, 2007. The median duration of follow-up was 37.3 months (range, 20.4 to 55.6). Data regarding vital status, current to within 3 months before study closure, were obtained for 100% of the patients who underwent randomization.
Compliance and Crossovers
In the AED group, 167 patients (4.8%) had a spouse or companion who was unable or unwilling to use the AED during follow-up. The corresponding number in the control group was 132 of 3272 patients (4.0%) for whom follow-up data were available. Crossover to therapy with an implantable cardioverter–defibrillator during follow-up occurred in 145 of 3435 patients in the AED group (4.2%) and in 155 of 3371 patients in the control group (4.6%).
Primary Outcome
A total of 450 patients died. Of these patients, 228 (6.5%) were in the control group, and 222 (6.4%) were in the AED group. As compared with the control group, the AED group had a similar risk of death (hazard ratio, 0.97; 95% confidence interval, 0.81 to 1.17; P=0.77). The mean annual mortality during 4 years of follow-up was 2.1% in the control group and 2.0% in the AED group (Figure 1Figure 1
Kaplan–Meier Curves for Death from Any Cause.). The primary outcome did not differ among the major prespecified subgroups according to the following factors: age (≥65 years vs. <65 years), sex, Q-wave versus non–Q-wave myocardial infarction, and nationality (United States vs. all other countries) (Figure 2Figure 2Hazard Ratios for Major Subgroups of Patients.). Treatment comparisons within subgroups were consistent with the overall study results, although the difference in treatment effect in patients with diabetes, as compared with those without diabetes, was statistically significant (P=0.04).Cause, Mode, and Circumstance of Death
The adjudicated cause and mode of death in each of the study groups are shown in Table 2Table 2
Frequency of Events and Hazard Ratios, According to the Classified Mode of Death and Resuscitated Cardiac Arrest.. Only 169 of the 450 deaths (37.6%) were deemed to be caused by tachyarrhythmia (i.e., consistent with ventricular fibrillation or ventricular tachycardia). Death was attributed to heart failure or nonarrhythmic cardiac causes in 96 patients (21.3% of deaths) and to noncardiac causes in 170 patients (37.8%). Thirteen deaths (2.9%) could not be classified because of insufficient data. There were no differences between the control group and the AED group in the adjudicated mechanisms of death for any category.Of the 169 deaths from cardiac tachyarrhythmia, 160 were from sudden cardiac arrest. The initial place of collapse was the home for 117 patients, a public place for 9 patients, a hospital or long-term care facility for 18 patients, and another or an unknown location for 16 patients (Table 2). Only 58 of the 117 sudden cardiac deaths from tachyarrhythmia occurring in the home (49.6%) were witnessed. Sudden cardiac deaths from tachyarrhythmia that occurred at home and were witnessed comprised 12.9% of all deaths and 36.3% of the sudden cardiac deaths from tachyarrhythmia. There were no significant differences between the study groups in the location of the patient at the time of death.
Resuscitated Cardiac Arrest
Thirty-eight patients were resuscitated from sudden cardiac arrest and survived for at least 48 hours (Table 2). Among 19 resuscitations in the control group, 8 occurred at home, 2 in a public place, 6 in a hospital or chronic care facility, and 3 in another or an unknown location. Among 19 resuscitations in the AED group, 8 occurred at home, 1 in a public place, 9 in a hospital or chronic care facility, and 1 in another location.
Use of an AED
During the trial, a study AED was applied to 32 patients in the AED group; of these patients, 29 were found unresponsive by a spouse, companion, or other household member. Correlative documentation of AED rhythms was available for 21 of 29 unresponsive patients (Figure 3Figure 3
Events and Outcomes Associated with the Use of an Automatic External Defibrillator (AED) in 32 Patients.).A shock was advised for confirmed ventricular fibrillation in 13 patients and was delivered in 12 of them. Of the 12 patients, 4 were long-term survivors, and another survived to hospital admission but died several days later. No shock was delivered in 1 of the 13 patients with ventricular fibrillation because a household member (not a spouse or companion) accidentally turned off the AED after the shock advisory. (This advisory was a verbal prompt from the AED to press the shock button; the power button was depressed inadvertently instead.) Of the remaining seven patients with ventricular fibrillation who died, AED shocks terminated ventricular fibrillation either to asystole or to a nonshockable rhythm. Monomorphic ventricular tachycardia was not identified in any patient.
A no-shock advisory was confirmed on the AED for eight of the unresponsive patients; of these patients, seven died, with a rhythm documented as asystole in five, complete heart block in one, and sinus tachycardia in one. One of the eight patients had sinus bradycardia and survived.
Of the 29 patients who were unresponsive, 8 did not have correlative AED rhythm information, but clinical information confirmed that an AED shock was delivered in 2 patients, both of whom died. Of the remaining 6 patients, 3 died and 3 had syncope from noncardiac causes and survived.
A no-shock advisory was given in the three patients who did not lose consciousness. There were no documented inappropriate shocks. Overall, 4 of the 14 patients with ventricular fibrillation (28.6%) who received an AED shock were long-term survivors.
Good Samaritan Use of AED
Over the course of the trial, the AED was known to have been used in seven persons having sudden cardiac arrest who were not participating in the HAT trial but were neighbors or visitors to the patients' homes. In three such cases, no shock was advised and all three persons died. In four cases, a shock was advised and terminated ventricular fibrillation, with two persons surviving beyond hospital discharge.
Discussion
In the HAT trial, we found that a strategy of placing an AED in the home did not reduce overall mortality in patients with a previous anterior-wall myocardial infarction who did not have an indication for implantation of a cardioverter–defibrillator, as compared with standard response training for cardiac arrest. Several factors may explain this finding. First, the overall mortality and the incidence of sudden cardiac arrest were much lower than predicted from historical data.13-15 This factor is probably a reflection of the efficacy and high level of use of modern drug therapy and the high rate of previous revascularization (72.2%) in the trial patients. As a result of these factors, the trial had substantially less power than initially projected. These effects were so profound that even a doubling in the population size would not have been sufficient to show an overall mortality benefit with home AED therapy. Remarkably, the enrolled patients were as likely to die from noncardiac causes (37.8% of deaths) as from sudden cardiac arrest from tachyarrhythmia (35.6%), with an annual risk of sudden cardiac arrest of less than 1% per year.
The training of the patients and their spouses or companions may have been an additional factor limiting the likelihood of a demonstrable benefit. All participants in the control group received resuscitation training, with frequent reminders; such education is not reflective of real-world instruction after myocardial infarction. At the same time, less than half the patients with sudden cardiac arrest at home had a witnessed event, and not all of them had the AED applied. This latter finding is particularly disconcerting, given the effort to inform partners or companions of the significance of AED use. Although the reasons for failure to deploy the AED are unclear, it is possible that a more aggressive AED reminder and retraining program might be required to ensure that lay rescuers would use the AED in a highly stressful situation. Such a program, however, would exceed the practical limits of a public health study, both in terms of personnel time and cost. Furthermore, to contend with events occurring when the patient is asleep or alone, it is conceivable that some form of a home automated alert system might be of value, but no such system is currently available.30
The successful delivery of a defibrillating shock in 14 patients and in 4 neighbors resulted in long-term survival for 6 (33%). This confirms that the use of an AED in the home or environs on loved ones or neighbors by lay users with minimal training is feasible, terminates ventricular fibrillation, and appears to carry no risk of inappropriate shock. The observed overall survival after sudden cardiac arrest in the home of 12.0% (18.3% for witnessed events) was significantly better than the figure of 2% that has previously been reported in the general population at home11 and better than the 6% performance provided by emergency medical services in general.31 However, the low event rate and the neutral outcome with respect to death from any cause suggest that the placement of AEDs in homes would be an inefficient strategy in public health terms, despite the value to patients who are fortunate enough to have the event witnessed and the AED applied.
It is important to recognize that our trial results may not apply to the use of AEDs in higher-risk populations. Candidates for implantation of a cardioverter–defibrillator were excluded from our trial, although physicians' judgment and a variety of practice patterns in the enrolling countries resulted in the inclusion of some patients who might otherwise have satisfied criteria for use of an implantable cardioverter–defibrillator in the Sudden Cardiac Death in Heart Failure trial or the Multicenter Automatic Defibrillator Implantation Trial II (Table 1).16-19 It is nonetheless possible that a population with a higher event rate and a greater proportion of sudden deaths from tachyarrhythmia might benefit from access to a home AED.
Although the performance of AEDs in this trial may seem at odds with that reported for public-access defibrillation, one must remember that the denominator of patients in our trial was precisely defined, whereas that for public-access defibrillation was not clear. For example, the annual passenger volume in Chicago's O'Hare airport now exceeds 76 million, and this massive cohort is exposed to AEDs placed throughout the airport at a distance of 1 minute's walk apart.8 No clinical trial of the use of AEDs could assemble a denominator representing even 1% of that volume. Furthermore, in a public venue, there is the opportunity to use an AED in treating any one of many persons at risk. This factor contrasts with the home AED strategy, in which there is the opportunity to treat only those in the immediate household or environs.
The survival of some patients with sudden cardiac arrest who were treated early with AEDs in public settings is generally taken as proof of concept that the therapy is effective, since sudden cardiac arrest is known to have a rate of death approaching 100% with conventional resuscitation methods. However, such uses of AEDs are not an efficient attack on the public health problem of sudden cardiac arrest in moderate-risk populations, since most at-risk patients do not spend a sufficient portion of each day in public locations.
In conclusion, our trial evaluated the benefit of the availability of AEDs in the homes of patients with a previous anterior-wall myocardial infarction who were not otherwise candidates for implantation of a cardioverter–defibrillator. There was no significant reduction in death from any cause with a home AED. The very low event rate, the high proportion of unwitnessed events, and the underuse of AEDs in emergencies, rather than a lack of device efficacy, appear to explain these results.
Supported by a grant (UO1-HL67972) from the National Heart, Lung, and Blood Institute.
Dr. Bardy reports receiving grant support from Philips Medical and Laerdal Medical and consulting fees from Philips Medical, having intellectual-property rights with Medtronic and Cameron Health, and having an equity interest in and serving on an advisory board for Cameron Health; Dr. Mark, receiving research support from Medtronic; Dr. Poole, receiving consulting fees from Philips Medical and lecture fees from Medtronic; Dr. Toff, receiving research support from Laerdal Medical and Cameron Health; Dr. Smith, receiving research support from and having an equity interest in Cameron Health; Dr. Dorian, receiving research support from Medtronic and St. Jude Medical and lecture fees from Medtronic, St. Jude Medical, and Boston Scientific; and Dr. Packer, receiving consulting fees and research support from and serving on an advisory board for Medtronic and receiving research support from Transoma and St. Jude Medical. No other potential conflict of interest relevant to this article was reported.
This article (10.1056/NEJMoa0801651) was published at www.nejm.org on April 1, 2008.
Source Information
From the Seattle Institute for Cardiac Research (G.H.B., J.A., G.J., E.B.) and the University of Washington (J.E.P., W.T.L.) — both in Seattle; the Duke University Clinical Research Institute, Durham, NC (K.L.L., D.B.M., S.M., L.D.R., N.E.C.-C.); the University of Leicester, Leicester, United Kingdom (W.D.T.); the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.M.T., J.J.Y.); Auckland City Hospital, Auckland, New Zealand (W.S., J.J.Y.); the University of Toronto, Toronto (P.D.); the Mayo Clinic, Rochester, MN (D.L.P., R.D.W.); and the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (Y.R., E.B.S.).
Address reprint requests to Dr. Bardy at the Seattle Institute for Cardiac Research, 7900 E. Green Lake Dr. N., #302, Seattle, WA 98103-4819, or at gbardy@sicr.org.
Investigators in the Home Automated External Defibrillator Trial (HAT) are listed in the Supplementary Appendix, available with the full text of this article at www.nejm.org.
- References
References
1
Rosamond W ,Flegal K ,Furie G , et al. Heart disease and stroke statistics -- 2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008;117:e25-e146
Web of Science | Medline2
Capucci A ,Aschieri D ,Piepoli MF ,Bardy GH ,Iconomu E ,Arvedi M . Tripling survival from sudden cardiac arrest via early defibrillation without traditional education in cardiopulmonary resuscitation. Circulation 2002;106:1065-1070
CrossRef | Web of Science | Medline3
Hallstrom AP ,Ornato JP ,Weisfeldt M , et al. Public-access defibrillation and survival after out-of-hospital cardiac arrest. N Engl J Med 2004;351:637-646
Full Text | Web of Science | Medline4
Cappato R ,Curnis A ,Marzollo P , et al. Prospective assessment of integrating the existing emergency medical system with automated external defibrillators fully operated by volunteers and laypersons for out-of-hospital cardiac arrest: the Brescia Early Defibrillation Study (BEDS). Eur Heart J 2006;27:553-561
CrossRef | Web of Science | Medline5
White R ,Bunch J ,Hankins D . Evolution of a community-wide early defibrillation programme: experience over 13 years using police/fire personnel and paramedics as responders. Resuscitation 2006;65:279-283
CrossRef | Web of Science6
Page RL ,Joglar JA ,Kowal RC , et al. Use of automated external defibrillators by a U.S. airline. N Engl J Med 2000;343:1210-1216
Full Text | Web of Science | Medline7
Valenzuela TD ,Roe DJ ,Nichol G ,Clark LL ,Spaite DW ,Hardman RG . Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med 2000;343:1206-1209
Full Text | Web of Science | Medline8
Caffrey SL ,Willoughby PJ ,Pepe PE ,Becker LB . Public use of automated external defibrillators. N Engl J Med 2002;347:1242-1247
Full Text | Web of Science | Medline9
Eisenberg MS ,Mengert TJ . Cardiac resuscitation. N Engl J Med 2001;344:1304-1313
Full Text | Web of Science | Medline10
Pell JP ,Sirel JM ,Marsden AK ,Ford I ,Walker NL ,Cobbee SM . Potential impact of public access defibrillators on survival after out of hospital cardiopulmonary arrest: retrospective cohort study. BMJ 2002;325:515-515
CrossRef | Web of Science | Medline11
Norris RM, UK Heart Attack Study (UKHAS) Collaborative Group
CrossRef | Web of Science | Medline12
Bardy GH ,Lee KL ,Mark DB , et al. Rationale and design of the Home Automatic External Defibrillator Trial (HAT). Am Heart J 2008;155:445-454
CrossRef | Web of Science | Medline13
Califf RM ,White HD ,Van der Werf F , et al. One-year results from the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO-I) trial. Circulation 1996;94:1233-1238
Web of Science | Medline14
Singh M ,White J ,Hasdai D , et al. Long-term outcome and its predictors among patients with ST-segment elevation myocardial infarction complicated by shock: insights from the GUSTO-I trial. J Am Coll Cardiol 2007;50:1752-1758
CrossRef | Web of Science | Medline15
Furman MI ,Dauerman HL ,Goldberg RJ ,Yarzebski J ,Lessard D ,Gore JM . Twenty-two year (1975 to 1997) trends in the incidence, in-hospital and long-term case fatality rates from initial Q-wave and non-Q-wave myocardial infarction: a multi-hospital, community-wide perspective. J Am Coll Cardiol 2001;37:1571-1580
CrossRef | Web of Science | Medline16
Zipes DP ,Camm AJ ,Borggrefe M , et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 2006;114:e385-e484
CrossRef | Medline17
Moss AJ ,Zareba W ,Hall WJ , et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002;346:877-883
Full Text | Web of Science | Medline18
Goldenberg I ,Vyas AK ,Hall WJ , et al. Risk stratification for primary implantation of a cardioverter-defibrillator in patients with ischemic left ventricular dysfunction. J Am Coll Cardiol 2008;51:288-296
CrossRef | Web of Science | Medline19
Bardy GH ,Lee KL ,Mark DB , et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005;352:225-237[Erratum, Engl J Med 2005;352:2146.]
Full Text | Web of Science | Medline20
American Heart Association 21
Home Use AED Trial (HAT) training videos. (Accessed March 28, 2008, at http://hat.sicr.org/media/.)
22
American Heart Association 23
Poole JE ,White RD ,Kanz KG , et al. Low-energy impedance-compensating biphasic waveforms terminate ventricular fibrillation at high rates in victims of out-of-hospital cardiac arrest. J Cardiovasc Electrophysiol 1997;8:1373-1385
CrossRef | Web of Science | Medline24
Gliner BE ,White RD . Electrocardiographic evaluation of defibrillation shocks delivered to out-of-hospital sudden cardiac arrest patients. Resuscitation 1999;41:133-144
CrossRef | Web of Science | Medline25
Kaplan EL ,Meier P . Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457-481
CrossRef | Web of Science26
Kalbfleisch JD, Prentice RL. The statistical analysis of failure time data. 2nd ed. New York: John Wiley & Sons, 2002.
27
Cox DR . Regression models and life-tables. J R Stat Soc [B] 1972;34:187-22028
O'Brien PC ,Fleming TR . A multiple testing procedure for clinical trials. Biometrics 1979;35:549-556
CrossRef | Web of Science | Medline29
Lan KKG ,DeMets DL . Discrete sequential boundaries for clinical trials. Biometrika 1983;79:659-663
CrossRef | Web of Science30
Saxon LA . Survival after tachyarrhythmic arrest -- what are we waiting for? N Engl J Med 2008;358:77-79
Full Text | Web of Science | Medline31
Nichol G ,Stiell IG ,Laupacis A ,Pham B ,De Maio VJ ,Wells GA . A cumulative meta-analysis of the effectiveness of defibrillator-capable emergency medical services for victims of out-of-hospital cardiac arrest. Ann Emerg Med 1999;34:517-525
CrossRef | Web of Science | Medline
- Citing Articles (51)
Citing Articles
1
D. G. Katritsis, M. E. Josephson. (2012) Sudden cardiac death and implantable cardioverter defibrillators: two modern epidemics?. Europace
CrossRef2
Peter P. Monteleone, Heather A. Borek, Seth O. Althoff. (2012) Electrical Therapies in Cardiac Arrest. Emergency Medicine Clinics of North America 30:1, 51-63
CrossRef3
W. Gaber, H.-J. Trappe. (2011) Frühdefibrillation am Flughafen Frankfurt. Der Kardiologe 5:6, 436-442
CrossRef4
J. Sjoblom, L. Ljung, M. Frick, M. Rosenqvist, V. Frykman. (2011) Primary prevention of defibrillator implantation after myocardial infarction: clinical practice and compliance to guidelines. Europace
CrossRef5
Erik P. Hess, Roger D. White. (2011) Automated External Defibrillation. Critical Care Clinics
CrossRef6
Gregory M. Marcus, Melvin M. Scheinman, Edmund Keung. (2011) The Year in Clinical Cardiac Electrophysiology. Journal of the American College of Cardiology 58:16, 1645-1655
CrossRef7
Thomas A. Dewland, Jeffrey E. Olgin, Byron K. Lee. (2011) Indications for a Wearable Cardioverter-Defibrillator. Cardiac Electrophysiology Clinics 3:3, 339-347
CrossRef8
Chika Nishiyama, Taku Iwami, Graham Nichol, Tetsuhisa Kitamura, Atsushi Hiraide, Tatsuya Nishiuchi, Yasuyuki Hayashi, Hiroshi Nonogi, Takashi Kawamura. (2011) Association of out-of-hospital cardiac arrest with prior activity and ambient temperature. Resuscitation 82:8, 1008-1012
CrossRef9
H.-J. Trappe. (2011) Herz-Kreislauf-Stillstand zu Hause oder an öffentlichen Plätzen. Der Kardiologe 5:3, 231-233
CrossRef10
2011. Passive Arrhythmias. , 230-265.
CrossRef11
Younghoon Kwon, Tom P. Aufderheide. (2011) Optimizing Community Resources to Address Sudden Cardiac Death. Heart Failure Clinics 7:2, 277-286
CrossRef12
Demetris Yannopoulos, Kostantinos Kotsifas, Keith G. Lurie. (2011) Advances in Cardiopulmonary Resuscitation. Heart Failure Clinics 7:2, 251-268
CrossRef13
Mahmoud Houmsse, Veronica Franco, William T. Abraham. (2011) Epidemiology of Sudden Cardiac Death in Patients with Heart Failure. Heart Failure Clinics 7:2, 147-155
CrossRef14
M. Santini, C. Pignalberi. (2011) Timing of defibrillator implant after acute myocardial infarction: what's new?. Europace 13:4, 455-457
CrossRef15
Robert W. Rho, Richard L. Page. (2011) Public Access Defibrillation. Heart Failure Clinics 7:2, 269-276
CrossRef16
Naohiko Nakanishi, Shinya Nishizawa, Yohei Kitamura, Takeshi Nakamura, Akiyoshi Matsumuro, Takahisa Sawada, Hiroaki Matsubara. (2011) The Increased Mortality from Witnessed Out-of-Hospital Cardiac Arrest in the Home. Prehospital Emergency Care 15:2, 271-277
CrossRef17
Bardy, Gust H., . (2011) A Critic's Assessment of Our Approach to Cardiac Arrest. New England Journal of Medicine 364:4, 374-375
Full Text18
Weisfeldt, Myron L., Everson-Stewart, Siobhan, Sitlani, Colleen, Rea, Thomas, Aufderheide, Tom P., Atkins, Dianne L., Bigham, Blair, Brooks, Steven C., Foerster, Christopher, Gray, Randal, Ornato, Joseph P., Powell, Judy, Kudenchuk, Peter J., Morrison, Laurie J., . (2011) Ventricular Tachyarrhythmias after Cardiac Arrest in Public versus at Home. New England Journal of Medicine 364:4, 313-321
Full Text19
Arthur G Money, Julie Barnett, Jasna Kuljis. (2011) Public Claims about Automatic External Defibrillators: An Online Consumer Opinions Study. BMC Public Health 11:1, 332
CrossRef20
R.W. Koster, M.A. Baubin, L.L. Bossaert, A. Caballero, P. Cassan, M. Castrén, C. Granja, A.J. Handley, K.G. Monsieurs, G.D. Perkins, V. Raffay, C. Sandroni. (2010) Basismaßnahmen zur Wiederbelebung Erwachsener und Verwendung automatisierter externer Defibrillatoren. Notfall + Rettungsmedizin 13:7, 523-542
CrossRef21
Jerry P. Nolan, Jasmeet Soar, David A. Zideman, Dominique Biarent, Leo L. Bossaert, Charles Deakin, Rudolph W. Koster, Jonathan Wyllie, Bernd Böttiger. (2010) European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation 81:10, 1219-1276
CrossRef22
Rudolph W. Koster, Michael A. Baubin, Leo L. Bossaert, Antonio Caballero, Pascal Cassan, Maaret Castrén, Cristina Granja, Anthony J. Handley, Koenraad G. Monsieurs, Gavin D. Perkins, Violetta Raffay, Claudio Sandroni. (2010) European Resuscitation Council Guidelines for Resuscitation 2010 Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation 81:10, 1277-1292
CrossRef23
Jasmeet Soar, Mary E. Mancini, Farhan Bhanji, John E. Billi, Jennifer Dennett, Judith Finn, Matthew Huei-Ming Ma, Gavin D. Perkins, David L. Rodgers, Mary Fran Hazinski, Ian Jacobs, Peter T. Morley. (2010) Part 12: Education, implementation, and teams. Resuscitation 81:1, e288-e332
CrossRef24
Jocelyn Berdowski, Mathijs J. Kuiper, Marcel G.W. Dijkgraaf, Jan G.P. Tijssen, Rudolph W. Koster. (2010) Survival and health care costs until hospital discharge of patients treated with onsite, dispatched or without automated external defibrillator. Resuscitation 81:8, 962-967
CrossRef25
Roger A. Winkle. (2010) The Effectiveness and Cost Effectiveness of Public-Access Defibrillation. Clinical Cardiology 33:7, 396-399
CrossRef26
H.-J. Trappe. (2010) Frühdefibrillation in Japan. Der Kardiologe 4:3, 236-238
CrossRef27
A. Selcuk Adabag, Russell V. Luepker, Véronique L. Roger, Bernard J. Gersh. (2010) Sudden cardiac death: epidemiology and risk factors. Nature Reviews Cardiology 7:4, 216-225
CrossRef28
Myron L. Weisfeldt, Colleen M. Sitlani, Joseph P. Ornato, Thomas Rea, Tom P. Aufderheide, Daniel Davis, Jonathan Dreyer, Erik P. Hess, Jonathan Jui, Justin Maloney, George Sopko, Judy Powell, Graham Nichol, Laurie J. Morrison. (2010) Survival After Application of Automatic External Defibrillators Before Arrival of the Emergency Medical System. Journal of the American College of Cardiology 55:16, 1713-1720
CrossRef29
Daniel B. Mark, Kevin J. Anstrom, Steven E. McNulty, Greg C. Flaker, Andrew M. Tonkin, Warren M. Smith, William D. Toff, Paul Dorian, Nancy E. Clapp-Channing, Jill Anderson, George Johnson, Eleanor B. Schron, Jeanne E. Poole, Kerry L. Lee, Gust H. Bardy. (2010) Quality of life effects of automatic external defibrillators in the home: Results from the Home Automatic External Defibrillator Trial (HAT). American Heart Journal 159:4, 627-634.e7
CrossRef30
Kitamura, Tetsuhisa, Iwami, Taku, Kawamura, Takashi, Nagao, Ken, Tanaka, Hideharu, Hiraide, Atsushi, . (2010) Nationwide Public-Access Defibrillation in Japan. New England Journal of Medicine 362:11, 994-1004
Full Text31
HELMUT U. KLEIN, ULF MELTENDORF, SVEN REEK, JAN SMID, SEBASTIAN KUSS, IWONA CYGANKIEWICZ, CHRISTIAN JONS, STEVEN SZYMKIEWICZ, FRANK BUHTZ, ANKE WOLLBRUECK, WOJCIECH ZAREBA, ARTHUR J. MOSS. (2010) Bridging a Temporary High Risk of Sudden Arrhythmic Death. Experience with the Wearable Cardioverter Defibrillator (WCD). Pacing and Clinical Electrophysiology 33:3, 353-367
CrossRef32
Thomas D. Rea, Michele Olsufka, Brock Bemis, Lindsay White, Lihua Yin, Linda Becker, Michael Copass, Mickey Eisenberg, Leonard Cobb. (2010) A population-based investigation of public access defibrillation: Role of emergency medical services care. Resuscitation 81:2, 163-167
CrossRef33
Jan Bahr, Leo Bossaert, Anthony Handley, Ruud Koster, Bart Vissers, Koen Monsieurs. (2010) AED in Europe. Report on a survey. Resuscitation 81:2, 168-174
CrossRef34
Byron K. Lee, Jeffery E. Olgin. (2009) Role of wearable and automatic external defibrillators in improving survival in patients at risk for sudden cardiac death. Current Treatment Options in Cardiovascular Medicine 11:5, 360-365
CrossRef35
Graham Nichol, Ella Huszti, Alice Birnbaum, Brian Mahoney, Myron Weisfeldt, Andrew Travers, Jim Christenson, Karen Kuntz. (2009) Cost-Effectiveness of Lay Responder Defibrillation for Out-of-Hospital Cardiac Arrest. Annals of Emergency Medicine 54:2, 226-235.e2
CrossRef36
Gregory M. Marcus, Edmund Keung, Melvin M. Scheinman. (2009) The Year in Review of Clinical Cardiac Electrophysiology. Journal of the American College of Cardiology 54:9, 777-787
CrossRef37
János Tomcsányi, Péter Bezzeg. (2009) Home ECG monitoring of high-risk post-myocardial infarction patients. Clinical and Experimental Medical Journal 3:2, 263-267
CrossRef38
Jacob Steinmetz. (2009) Cardiac arrest – Midway between two guidelines: From an anaesthesiologist's point of view. Current Anaesthesia & Critical Care 20:3, 113-119
CrossRef39
János Tomcsányi, Péter Bezzeg. (2009) Otthoni EKG-monitorozás magas rizikójú posztinfarktusos betegeken. Orvosi Hetilap 150:21, 985-988
CrossRef40
Barry J. Maron, Christopher Semsarian, Win-Kuang Shen, Mark S. Link, Andrew E. Epstein, N.A. Mark Estes, Adrian Almquist, Michael C. Giudici, Tammy S. Haas, James S. Hodges, Paolo Spirito. (2009) Circadian patterns in the occurrence of malignant ventricular tachyarrhythmias triggering defibrillator interventions in patients with hypertrophic cardiomyopathy. Heart Rhythm 6:5, 599-602
CrossRef41
Derek V Exner. (2009) Implantable cardioverter defibrillator therapy for patients with less severe left ventricular dysfunction. Current Opinion in Cardiology 24:1, 61-67
CrossRef42
Thomas E. Kottke, Dennis A. Faith, Courtney O. Jordan, Nicolaas P. Pronk, Randal J. Thomas, Simon Capewell. (2009) The Comparative Effectiveness of Heart Disease Prevention and Treatment Strategies. American Journal of Preventive Medicine 36:1, 82-88.e5
CrossRef43
Giuseppe Ristagno, Wanchun Tang, Max Harry Weil. (2009) Cardiopulmonary Resuscitation: From the Beginning to the Present Day. Critical Care Clinics 25:1, 133-151
CrossRef44
José A. Barrabés, Juan Sanchís, Pedro L. Sánchez, Alfredo Bardají. (2009) Actualización en cardiopatía isquémica. Revista Española de Cardiología 62, 80-91
CrossRef45
S. Rosenheck, S. Gorni, I. Katz, A. Rabin, U. Shpoliansky, M. Mandelbaum, A. T. Weiss. (2008) Modified alternating current defibrillation: a new defibrillation technique. Europace 11:2, 239-244
CrossRef46
Sumeet S. Chugh, Kyndaron Reinier, Carmen Teodorescu, Audrey Evanado, Elizabeth Kehr, Mershed Al Samara, Ronald Mariani, Karen Gunson, Jonathan Jui. (2008) Epidemiology of Sudden Cardiac Death: Clinical and Research Implications. Progress in Cardiovascular Diseases 51:3, 213-228
CrossRef47
Howard K. Mell, Michael R. Sayre. (2008) Public Access Defibrillators and Fire Extinguishers: Are Comparisons Reasonable?. Progress in Cardiovascular Diseases 51:3, 204-212
CrossRef48
(2008) Provision of AEDs may not improve survival after sudden cardiac arrest at home. Nature Clinical Practice Cardiovascular Medicine 5:10, 597-597
CrossRef49
(2008) Home Automated Defibrillators after Myocardial Infarction. New England Journal of Medicine 359:5, 533-535
Full Text50
Javier Segovia, Javier Bermejo, Fernando Alfonso. (2008) Resumen de los ensayos clínicos presentados en la 57.a Sesión Científica Anual del American College of Cardiology (Chicago, Estados Unidos, 30 de marzo-2 de abril de 2008). Revista Española de Cardiología 61:7, 726-737
CrossRef51
Callans, David J., . (2008) Can Home AEDs Improve Survival?. New England Journal of Medicine 358:17, 1853-1855
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