The most common cause of sudden cardiac death is blocked left anterior descending artery.
Generally this is unknown until it happens.
It kills 250,000 Americans every year.
It would make the most sense for people above 50 with a family history of heart disease to have a CT coronary angiogram or for those above 40 to have a Cardiac Calcium Score to risk stratify for future CTCA.
Distributing AEDs is infrastructure heavy and indiscriminate because you don’t know who actually needs one.
In the UK, in addition to what the sibling comment mentioned about phone boxes, a lot of workplaces now have AEDs on site (eg I know mine does) and they're also common at large-scale events. I don't know if there are any statistics on how much good they've done but that seems like quite a sensible approach to me as you can presumably get quite a lot of population coverage quite cheaply.
By contrast, a CT coronary angiogram I suspect is rather more resource heavy - in particular I suspect having enough qualified cardiologists to interpret the results (not just having CT machines and staff to administer the test) might be a bottleneck (anecdotal, but having had one myself due to family history of heart disease, I had a longer wait for results after the scan than to get the scan itself).
It’s risk stratification vs preventative care. You don’t WANT someone to have a heart attack and require the AED, because you’ve only got a 5-20% chance of making it out of hospital.
These things are not équivalant!!!
Risk stratification for AEDs at work and public events, whereas screening should increasingly be part of the plan particularly if you have a family history (defined as 1 or more relatives who died younger than 65 from a heart attack)
CTCA doesn’t require a cardiologist, just a radiologist, but a cardiologist referral makes it free (in australia) otherwise it’s $500. Which is pretty good really
Quite a lot of people/families can find £500-1000 for something important. The more that can, the cheaper it will become.
AEDs/Defibs are just an expensive battery powered thing, that we just don't bother to discuss. With around an hour or less training, you can expect to be at least 10x more effective than the best CPR. CPR is horrible to deploy and very complicated but I will if I have no choice.
They’re not equivalent though! An AED means your heart muscle has been absolutely trashed and will never be the same again. Plus, there’s still the issue of who actually needs an AED in their house, and if you know that, they’ve probably got an IED.
Whereas if you can for the same cost have a scan after being reviewed appropriately, you can avoid the heart muscle trashing. That is nothing short of a miracle in terms of the extension of lifespan available
Firstly, the people most at risk of cardiac arrest are unlikely to regain any meaningful quality of life after resuscitation. An AED might bring a very elderly and/or very ill person back from the dead, but more often than not they'll be just barely alive afterwards, which is not an outcome that most people would choose for themselves. People who are close to the end of their natural lives would benefit much more from serious conversations about end-of-life care than expensive gadgets and false hope.
Secondly, most of the risk of cardiac arrest in younger and relatively healthier people is preventable. If you're not a frail elderly person but you consider yourself at risk of cardiac arrest, it's very likely that you're at least one of: obese, sedentary, hypertensive, poorly-managed diabetic. Before you go out and buy an AED, give some serious thought to what kind of state you'd be in after surviving a cardiac arrest and to whether you'd rather take meaningful action to improve your health now.
Some people with cardiac abnormalities might be good candidates for an at-home AED, but they'd generally be better candidates for an ICD. A young and otherwise healthy person with a condition like LQTS, Brugada or severe HCM is at very real risk of sudden cardiac arrest, but the most likely trigger for that arrest would be strenuous physical exercise - something that most of us don't do in our own homes.
> personal history of sudden cardiac death with a persistent risk factor
Personal history, or family history? Maybe this is a technical term? As a non-medic I can’t imagine there are many people who have a history of sudden death AND a persistent risk of it happening again.
"Many" is relative. We are talking about a fraction of a percent of the general population, but if you are looking specifically at the population of people who have some form of long standing heart disease, it's not terribly rare. I don't work in cardiology specifically, and even so I encounter one or two patients a year who have had an ICD placed for reason #3.
Persistent risk factors include things like or overgrowth of muscular heart tissue (which has dozens of causes, but the most common is severe, long standing coronary artery disease) or scarring of the heart after a heart attack.
Persistent risk factors are not rare at all. The thing is that most people who fall into bucket 3 also fall into buckets 1 or 2. So in an ideal world they would have already seen a cardiologist and had an ICD placed before they ever had an episode of SCD. And of course many of those who do have SCD don't survive long enough to have an ICD placed.
If you are interested in reading more, you can search for "secondary prevention of sudden cardiac death" or "secondary prophylaxis of sudden cardisc death." There are some good review articles available online.
I would say yes. Some of the answers here are referring to population stats and you are worrying about your particular circumstances, which is different.
If someone you come across (family, stranger, whatever) keels over you need to, without proper medical knowledge, diagnose the issue and then administer appropriate treatment. Oh and could you do it within a couple of minutes please.
CPR should be a last resort - it can be rather barbaric. A defib has a way better chance of success and won't break your ribs.
A defib costs around £1000 or so. Hopefully that money is wasted.
Generally this is unknown until it happens.
It kills 250,000 Americans every year.
It would make the most sense for people above 50 with a family history of heart disease to have a CT coronary angiogram or for those above 40 to have a Cardiac Calcium Score to risk stratify for future CTCA.
Distributing AEDs is infrastructure heavy and indiscriminate because you don’t know who actually needs one.