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Heart Attacks in Women
|What Is A Home Defibrillator?
It is a portable automated external defibrillator (AED) device which is suitable for treating sudden cardiac arrest (SCA) in the home. SCA is where the heart suddenly stops beating due to an internal electrical fault (technically called heart arrhythmia). AED home devices may be recommended to patients at high risk of SCA, including those who have undergone heart transplant surgery. One of the most popular devices on the market is the Philips HeartSmart Home Defibrillator. It is the first home device not to require a prescription and is considered safe and easy to use by anyone. Other manufacturers include Zoll Medical, HeartSine Technologies and Cardiac Science but these require a physician’s prescription. Only about 5 percent of victims who suffer SCA will survive, and some studies put this as low as 2 percent if it occurs in the home. The only known method to restart a heart which has stopped due to SCA is to treat it with electric shock (defibrillation). The victim only has a window of 3 to 5 minutes for this to occur. While many patients at high risk of SCA will be considered for an internal cardioverter defibrillator (ICD) - that is a small battery operated device which is implanted under the skin and automatically delivers small electric shocks to the heart if needed - ICDs are not medically suitable for everyone.
How Do I Use One?
A defibrillator is used on someone in sudden cardiac arrest. This means their heart has stopped. SCA is different to a heart attack where the heart still beats but is strangled of blood due to a blockage in one of the arteries supplying it. The 3 typical signs of SCA are:
• The person collapses unconscious.
• Their breathing stops.
• Their pulse stops.
If you suspect someone is in SCA, first dial 911 and request an ambulance. Then grab your home defibrillator - we will use the HeartSmart as an example (other brands may vary slightly in procedure, always read the instructions carefully). Next:
• Pull the cartridge handle marked PULL. This initiates the program and a computerized voice will lead you through the process.
• Remove the person's upper clothes to reveal the bare chest. Place the pads on the chest, the voice will instruct you where.
• Once the pads are in place the device starts analyzing the patient's heart rhythm and decides if an electric shock is needed.
• If a shock is needed, press the flashing orange button. The device is designed only to deliver a shock if it determines one is needed (so for example if the person has just fainted it will not deliver a shock). It can even provide cardiopulmonary resuscitation (CPR) training.
How Useful Are They?
One large-scale study reported in The New England Journal of Medicine in 2008 reported that home defibrillators were not particularly useful. More than 7,000 patients at risk of SCA due to previous heart attacks were monitored, and it found that those who had home defibrillators died at the same rate as those who did not. The government supported trial used the Philips HeartSmart Home Defibrillator for the tests. A spokesperson for cardiac care at Philips noted that half the incidents occurred when no one was around to witness them, which suggests there may be a market for a better alert system. The American Heart Association commented that despite the study's findings, home defibrillators may still be a good investment in remote areas where emergency response time is slow. Currently home defibrillators only account for $20 million of the $200 million market for portable defibrillators used outside of hospitals. Researchers noted that defibrillators found in public areas such as airports and sports stadiums clearly saved lives, not least because trained personnel are on duty nearby.
Other Useful Articles:
Understanding silent heart attacks.
Heart attack symptoms and heart attack questions.
When is CPR necessary?
How is hands only CPR performed?
How Much Do They Cost?
On average devices cost about $1,500 (€1,200). Some insurance companies, including Medicare will cover the costs in certain instances.
An AED is covered by Medicare for patients in two circumstances. A patient must meet either (1) both criteria A and B or (2) criteria C. The terms are quite technical, so you may need to discuss it with your doctor to determine your eligibility:
A. You have one of the following conditions (1 to 5):
1. A documented sudden cardiac arrest caused by ventricular fibrillation and not due to a temporary or reversible cause.
2. A sustained (lasting at least 30 seconds) ventricular tachyarrhythmia, either spontaneous or induced during an electrophysiologic (EP) study (a test which looks at the heart's electrical function), not associated with acute myocardial infarction (techie term for heart attack) and not due to a transient or reversible cause.
3. Genetically inherited or familial conditions with a high risk of life-threatening ventricular tachyarrhythmias (such as long QT syndrome or hypertrophic cardiomyopathy).
4. Coronary heart disease with a documented prior heart attack with a measured left ventricular ejection fraction less than or equal to 0.35 which is inducible, sustained ventricular fibrillation (VF) or ventricular tachycardia (VT) during an EP study. To meet this criterion:
a. The heart attack must have occurred more than 4 weeks ago.
b. The EP test must have been performed more than 4 weeks after the heart attack.
5. A documented heart attack (heart attack tests carried out) with a measured left ventricular ejection fraction less or equal to 0.30 and a QRS duration of greater than 120 milliseconds. Patients must not have:
a. New York Heart Association classification IV. Or
b. Cardiogenic shock or symptomatic hypotension while in a stable baseline rhythm. Or
c. Had a heart bypass surgery (CABG) or coronary angioplasty within the past 3 months. Or
d. Had an enzyme-positive heart attack within past 4 weeks. Or
e. Clinical symptoms that make you a candidate for coronary revascularization. Or
f. Irreversible brain damage from preexisting cerebral disease. Or
g. Any disease, other than cardiac disease (such as cancer or liver failure) that makes the likelihood of your chance of survival less than one year.
B. And implantation surgery is not possible.
C. A previously implanted defibrillator now requires taking out.
Talk To Your Doctor
If you think you may qualify, then take the following steps:
1. Talk to your doctor to help decide if a home defibrillator is right for you.
2. If he thinks it is, ask him to write a prescription and document your condition.
3. Contact the home defibrillator manufacturer of your choice and tell them you wish to order a defibrillator under Medicare coverage. They will refer you to a provider in your area. If you wish to order a HeartSmart, call Philips at 1-866-DEFIBHOME (1-866-333-4246).
4. Contact your local supplier to place the order. They will need the prescription from your doctor. If you are buying it privately from Philips, the prescription is not necessary. It will still be necessary with other manufacturers.