Gary Screaton Page, O.M.C., M.Ed., Ph.D., R.C.C.*


 *Under Letters Patent Government of Canada


    Is There Life After A Heart Attack?

    Been there; done that! But, I didn't need a defibrilator when I had my heart attack. But what if you have a heart attack and need an AED, Automatic External Defibrillator?

    I’m not so sure that you would survive if you live in Ontario. At least I'm not sure since reading the conclusions reported in the Ontario Prehospital Advanced Life Support (OPALS) study and the Public Access Defibrillation (PAD) trial.

    “These studies, reported on the Health Quality Ontario site, examined the effect of a community program to respond to cardiac arrest with and without the use of AEDs. Their authors had reported a significant reduction in overall mortality from cardiac arrest with the use of AEDs.

    “Of the 85% cardiac arrests that occur in homes, 56% occur in single residential dwellings (houses), 23% occur in multi-residential dwellings (apartments/condominiums), and 6% occur in nursing homes. There is no program in place except the 911 system to reach these patients.

    “One model for the use of AEDs in out-of-hospital settings was examined in the OPALS study. Firefighters and police were trained and provided with AEDs. The total initial cost (in US dollars) of this program was estimated to be $980,000. The survival rate was 3.9% before implementing the AED program and 5.2% after its implementation (OR, 1.33; 95% CI, 1.03-1.7; P = .03). Applying these estimates to cardiac arrest rates in Ontario in 2002, one would expect 54 patients of the total 1,395 cardiac arrests to survive without AEDs compared with 73 patients with AEDs; thus, 19 additional lives might be saved each year with an AED program. It would initially cost $51,579 to save each additional life.”

    Note, however, that “in subsequent years the total cost would be lower by about $50,000 per year”! That means after the first year, it would cost only $2,632 to save each additional life.

    “Results from this review suggest that the incidence of cardiac arrest in out-of-hospital setting in Ontario is 59 per 100,000 people. The mean age of cardiac arrest patients is 69 years. Eighty-five percent of these cardiac arrests occur in homes. Of all the cardiac arrests, 37% have heart rhythm abnormalities (ventricular tachycardia or ventricular fibrillation) that are correctable by delivering shock through an AED.

    “Thus,” reported the Health Quality Ontario site, “in an out-of-hospital setting, general use of AEDs by laypersons would not be cost-effective.” Special programs are needed in the out-of-hospital setting for cost-effective use of AEDs.”

    Not cost effective for whom? Certainly cost effective for the 19 people in Ontario who survived because of AED’s in 2002. Surely even more cost effective for the additional lives that would be saved now!

    The article at the HQO site goes on to conclude that, “Special programs are needed in the out-of-hospital setting for cost-effective use of AEDs.”

    I for one would like to see those programs made available as widely as possible. I would also like to se an AED in every public building and every church, synagogue, temple, etc. Who knows the life saved may be your own. 


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