HAT Related Disclosures Gust H. Bardy, MD Research grants – United States National Heart Lung and Blood Institute Research grants – Philips Medical Systems Research grants – Laerdal Medical Systems Consultant – Philips Board membership, equity, intellectual property – Cameron Health Intellectual property – Medtronic
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HAT Related Disclosures Gust H. Bardy, MD Research grants – United States National Heart Lung and Blood Institute Research grants – Philips Medical.
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HAT Related Disclosures Gust H. Bardy, MD
Research grants – United States National Heart Lung and Blood Institute
Research grants – Philips Medical Systems
Research grants – Laerdal Medical Systems
Consultant – Philips
Board membership, equity, intellectual property – Cameron Health
Intellectual property – Medtronic
The Home Automated External Defibrillator Trial (HAT)
April 1, 2008 American College of Cardiology
Chicago, Illinois
HAT Investigative Team Gust H. Bardy: PI – Coordinating Center, Seattle Institute for Cardiac Research
– Jill Anderson, George Johnson, Eric Bischoff, Amanda Brown, Crystal Munkers
Kerry L. Lee: Co-PI Biostatistics – Duke University– Steve McNulty, Meredith Smith, Phillip Smith
Daniel B. Mark: EQOL – Duke University– Nancy Clapp-Channing, Linda Davidson-Ray, Diane Marshall-Liu
Jeanne E. Poole: AED Data Core Lab – University of Washington
Roger D. White: EMS Coordination – Mayo Clinic
Douglas L. Packer: SCA/Death Analysis – Mayo Clinic
W.T. Longstreth, Jr.: Neurological outcomes – University of Washington
Paul Dorian: University of Toronto, Canadian Country PI– Katherin Allen
Warren Smith: Auckland General Hospital, New Zealand Country PI– Julie Yallop
William D. Toff: University of Leicester, United Kingdom Country PI
Andrew M. Tonkin: Monash University, Australia Country PI– Julie J. Yallop
Eleanor B. Schron, Yves Rosenberg, Jerry Fleg, Michael Proschan, Nancy Geller: U.S. National Heart Lung Blood Institute
Erika Friedmann, Sue Thomas: University of Maryland
HAT Funding
U.S.A. National Institutes of Health, Heart, Lung and Blood Institute
Philips Medical
Laerdal MedicalAEDs and supplies
HAT: Background
SCA occurs every 2-3 minutes in the U.S. 50% have no known heart disease 70% occur in the home 50% of home SCA occurs in the bedroom or
adjacent bathroom VF in 90% of SCA Death risk increases 10% per minute of collapse
Expected Survival for OOH-VF
Weaver WD et al. NEJM 2002; 347:1223
0
20
40
60
80
100
1 2-7 8-15
Su
rviv
al (
%)
Estimated Time from Collapse to Defibrillator Shock(minutes)
Type of MI Anterior non Q-wave 2491 1.13 (0.85-1.51)Anterior Q-wave 4509 0.88 (0.69-1.12)
0.25 1 4
Conclusions
• HAT evaluated the all-cause mortality benefit of AEDs in the homes of patients with a previous anterior-wall MI who were not otherwise candidates for an ICD.
Conclusions
• HAT evaluated the all-cause mortality benefit of AEDs in the homes of patients with a previous anterior-wall MI who were not otherwise candidates for an ICD.
• Mortality rates over 4 years of follow-up were low, ~half the level expected from prior data.
Conclusions
• HAT evaluated the all-cause mortality benefit of AEDs in the homes of patients with a previous anterior-wall MI who were not otherwise candidates for an ICD.
• Mortality rates over 4 years of follow-up were low, ~half the level expected from prior data.
• AEDS were used without any adverse consequences or inappropriate shocks.
Conclusions
• HAT evaluated the all-cause mortality benefit of AEDs in the homes of patients with a previous anterior-wall MI who were not otherwise candidates for an ICD.
• Mortality rates over 4 years of follow-up were low, ~half the level expected from prior data.
• AEDS were used without any adverse consequences or inappropriate shocks.
• There was no significant reduction in death from any cause with a home AED.
Conclusions
• HAT evaluated the all-cause mortality benefit of AEDs in the homes of patients with a previous anterior-wall MI who were not otherwise candidates for an ICD.
• Mortality rates over 4 years of follow-up were low, ~half the level expected from prior data.
• AEDS were used without any adverse consequences or inappropriate shocks.
• 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.