• Gust H Bardy, Kerry L Lee, Daniel B Mark, Jeanne E Poole, William D Toff, Andrew M Tonkin, Warren Smith, Paul Dorian, Douglas L Packer, Roger D White, W T Longstreth, Jill Anderson, George Johnson, Eric Bischoff, Julie J Yallop, Steven McNulty, Linda Davidson Ray, Nancy E Clapp-Channing, Yves Rosenberg, Eleanor B Schron, and HAT Investigators.
• Seattle Institute for Cardiac Research, Seattle, WA 98103-4819, USA. gbardy@sicr.org
• N. Engl. J. Med. 2008 Apr 24; 358 (17): 1793-804.

BackgroundThe 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.MethodsWe 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.ResultsThe 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.ConclusionsFor 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 [ClinicalTrials.gov].).Copyright 2008 Massachusetts Medical Society.

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