Quality of Life Effects of Automatic External Defibrillators in the Home: Results from the Home Automatic External Defibrillator Trial (HAT)

Daniel B. Mark, MD, MPH; Kevin J. Anstrom, PhD; Steven E. McNulty, MS; Greg C. Flaker, MD; Andrew M. Tonkin, MD, FRACP; Warren M. Smith, MB, BS, FRACP; William D. Toff, MD; Paul Dorian, MD; Nancy E. Clapp-Channing, RN, MPH; Jill Anderson, RN, BSN; George Johnson, BSEE; Eleanor B. Schron, RN, PhD; Jeanne E. Poole, MD; Kerry L. Lee, PhD; Gust H. Bardy, MD

Disclosures

Am Heart J. 2010;159(4):627-634. 

In This Article

Abstract and Introduction

Abstract

Background Public access automatic external defibrillators (AEDs) can save lives, but most deaths from out-of-hospital sudden cardiac arrest occur at home. The Home Automatic External Defibrillator Trial (HAT) found no survival advantage for adding a home AED to cardiopulmonary resuscitation (CPR) training for 7,001 patients with a prior anterior wall myocardial infarction. Quality of life (QOL) outcomes for both the patient and spouse/companion were secondary end points.
Methods A subset of 1,007 study patients and their spouse/companions was randomly selected for ascertainment of QOL by structured interview at baseline and 12 and 24 months after enrollment. The primary QOL measures were the Medical Outcomes Study 36-Item Short-Form psychological well-being (reflecting anxiety and depression) and vitality (reflecting energy and fatigue) subscales.
Results For patients and spouse/companions, the psychological well-being and vitality scales did not differ significantly between those randomly assigned an AED plus CPR training and controls who received CPR training only. None of the other QOL measures collected showed a clinically and statistically significant difference between treatment groups. Patients in the AED group were more likely to report being extremely or quite a bit reassured by their treatment assignment. Spouse/companions in the AED group reported being less often nervous about the possibility of using AED/CPR treatment than those in the CPR group.
Conclusions Adding access to a home AED to CPR training did not affect QOL either for patients with a prior anterior myocardial infarction or their spouse/companion but did provide more reassurance to the patients without increasing anxiety for spouse/companions.

Introduction

Automated external defibrillators (AEDs) can be used to identify and promptly terminate ventricular fibrillation and ventricular tachycardia in patients with sudden cardiac arrest (SCA). They may thereby allow bystanders to administer potentially lifesaving therapy critical minutes earlier than can be accomplished by emergency medical personnel. As a consequence, AEDs are increasingly being deployed in public places, such as airports and shopping malls; and available evidence suggests that they do increase survival to hospital discharge after an SCA.[1–4] However, the impact of public access AEDs on overall morbidity and mortality after SCA is limited, as approximately 75% of out-of-hospital SCAs occur in the home.[1,5]

We conducted the Home Automatic External Defibrillator Trial (HAT), an international, multicenter, randomized clinical trial, to compare the effect of placing an AED in the home versus no home AED in 7,001 stable patients with a prior anterior myocardial infarction (MI). Spouses/companions in both treatment groups were taught cardiopulmonary resuscitation (CPR) and instructed to call emergency medical services (EMS) promptly. As previously reported, home access to an AED had no significant effect on all-cause mortality.[5]

Previous studies on the psychosocial and other quality of life (QOL) effects of home AEDs for patients and their spouse/companions have been small and inconclusive. In a randomized trial of 158 patients with a recent acute ischemic event, home AED access was associated with trends toward worse QOL on most subscales of the Short-Form–36, particularly for social functioning.[6] Two smaller interview studies with patients and their spouses/companions suggested that access to a home AED improved feelings of security and control.[7,8] We examined the QOL effects of home access to AEDs in a randomly selected subset of patients and their spouses/companions enrolled in HAT.

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