A recent study has been published and discussed in the newspapers suggesting that people with heart disease do not receive substantial benefit by having an automatic external defibrillator (AED) in their home. What does this mean for those who have them, have considered getting them, must consider replacement of batteries, etc? What does this mean to the rest of us?
Automatic external defibrillators cost a considerable amount of money. The only use for an AED is to resuscitate someone from sudden death as many survivors could potentially lead productive lives. A patient that I saw yesterday is an example. Although he has known cardiomyopathy, diagnosed before age 30, he is currently in his 40’s and active with an internal defibrillator in place. This defibrillator was placed two years ago, after he had a cardiac arrest, and was resuscitated at his workplace. His workplace has 1,000 employees pass through it per day, and many visitors. Thus, the chances that a sudden death will happen and a person will benefit are increased when compared to a home with less than 10 people in it, even if one or two have known heart conditions. The benefit of having AEDs available in places where large amounts of people may pass through or congregate is incontestable. This is the reason that they are mandated for airplanes, airports and many public buildings, including stadiums.
The question that the study referred to asked if providing a device to every family with a patient at risk would provide a benefit. The answer was no. This is not a surprise. The use of an AED requires the presence of another person to use it at the time of a cardiac arrest. I have had family members with heart disease at risk of sudden death. They did not stay home 24 hours per day, and when they were home, they did not always have someone there with them. The device would not have been used when others were asleep. And thus, despite “high risk”, the actual possible benefit would be limited to a scarce few hours per day around mealtime. Actually, the risk of death in the study was 2% per year, and only about half of that was from sudden death. So, at the very outset, only one patient in a hundred could have benefited even had someone been there to use the device 24 hours per day.
Would such a device reassure patients that they are protected and therefore give psychological benefit? I am not sure. Would such a device be a constant reminder of impending doom, and therefore have a negative effect? I can’t answer that either. These, however, are questions that must be considered when buying, or replacing the expensive batteries for such devices.
Most doctors’ offices do not have an AED despite the fact that they see sick patients. I have had a defibrillator in the office for years as a “just in case” for myself and for my colleagues in the building, although we keep ready, it has not seen use except as a monitor.
If you have such a device and have decided to divest yourself of it for whatever reason, please do not donate it to the landfill or garbage dump. The batteries in it do not belong there. And it is a valuable piece of equipment that if put into the right hands can save a life. Please consider asking your local heart or medical association, town, hospital, church or schools if there is some way of making a contribution of this equipment and if they can place it somewhere useful. You might even get a tax deduction.