Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, my name is Dr Warrick Bishop and I'd like to welcome you to my podcast and videocast station and of course welcome you to the Healthy Heart Network. Today I would like to talk a little bit about automatic home defibrillators. So as I mentioned, I'd like to talk about home-based defibrillators. in Australia and in America, we are able to buy these devices off the shelf. Now, right at the moment, down the road at Harvey Norman here in Hobart, you could go out and spend $2,000 to buy a home-based cardiac defibrillator to use in the setting of coronary arrest or heart attack. And heart attack that drops people like this is not just the artery blocking. What it is is the artery being blocked, but the muscle being so irritated by that lack of blood flow that it goes into a lethal or malignant rhythm. That malignant rhythm is called either ventricular tachycardia, so the ventricle main pumping chamber of the heart goes very fast, or ventricular fibrillation. Fibrillation meaning out of control and twitching without any real structure to it, any organisation to it. In ventricular tachycardia and ventricular fibrillation, an electrical shock can restore rhythm and save a life. So where do home-based electrical defibrillators work? Well, there was a study done in 2008 that looked just at this question. They took about 7,000 people, so a good number. They took people who had high risk of dying from a heart attack, so people with no and coronary disease, and they randomised them into people who got home defibrillators and those who didn't. It turns out after their study period that they found no statistical difference between the people who had a defibrillator device at home and those who did not. Well, that probably means that it's not a leaps and bounds benefit. But there were a number of cases, although limited within the study, who did get defibrillated and whose lives were saved. So there was about four people out of that study population, four out of three and a half thousand. So statistically, not a lot, but pretty significant if you were one of the three or four. So the interesting thing about this is that there have been studies looking at the role of automatic defibrillators, and there has been good evidence to suggest that these are certainly valuable in areas where there's large numbers of people, like sporting events or shopping malls. And I think we're seeing these devices being used more and more in that situation. When it comes to the home, though, the numbers are just not there to make it statistically significant or necessarily viable. It certainly raises the question that perhaps certain situations, such as neighbourhoods who purchase these devices, may find them beneficial. So a small cul-de-sac, for example. A small shopping... area near where you live might be useful as well. I think it's really important not to forget that just having a defibrillator of its own is not enough to save someone's life. You certainly need some education and training around it and you need good cardiopulmonary resuscitation skills to work with that. The other really important thing to try and understand is that when we do identify very high risk patients, these are people who have had a heart attack and damaged a large part of their heart so that their heart's not pumping as well as it should, then these patients will often be given an implantable automatic defibrillator. So we call those ICDs, implantable cardiac. And those devices, for those very high-risk patients with poor heart function and a big scar from a previous heart attack, there's no question that those implantable devices have been shown to work because they're there immediately. You can imagine if you've got your home defibrillator sitting in the kitchen and you're down at the bottom of the garden and your partner is at the shop and you have a cardiac arrest. then the defibrillator is never going to have the chance to work. My concern is that people may end up buying these devices when they're actually at low risk and my feeling is that it's probably better to invest that money or some of that money into getting a scan of your heart so you can be most clear about exactly what's going on in your arteries rather than plan for a high risk. presentation, which is a cardiac arrest, why not scan the heart and actually see what's going on with the arteries and figure out the likelihood of that event occurring before assuming it might. So I think for people to be purchasing these devices willy-nilly in the community makes little sense. I think that there's probably some sense in thinking about them being clustered around small neighbourhoods. I think that if you really did think you're high risk, you probably should be asking your doctor if you need an implantable defibrillator. I think your money may be better spent by being proactive about finding out exactly what the health of your arteries is rather than assuming the worst. I think if you are associated with sporting clubs or sporting groups, particularly sporting groups that may have a number of individuals around who are a little bit older, maybe golf, maybe bowls, then it could be a really good idea for those clubs to chip in and buy one of these defibrillators and have it available. My dad attends the University of the Third Age and there are people who are in there. autumnal years who attend that and perhaps that sort of group demographic would do really well with everyone chipping in and having one of these automatic defibrillators there. I think one of the limitations is always going to be location of the device and where you are when something goes wrong. It is quite possible though that as the cost of these devices gets less and less we may actually see them. routinely sold as part of other equipment that we see routinely. And I'm thinking that we may actually see these devices regularly occur in cars. They may get down to as little as $500. And if that's the case, then they may end up being in our car. Their battery is constantly being charged through the car. If you are at home, then people will know exactly. where the device is without too much concern. So is a home-based cardiac defibrillator for you, yes or no? I'm going to let you talk with your doctor about it. My gut feeling is it's not a great idea for everyone broadly. My feeling is if you do want to know what your risk of heart attack is, you're better off getting your heart scanned and then dealing with that as appropriate. If you truly, really are at high risk, but you're not bad enough to qualify for an implantable cardiac defibrillator, one that goes in under the skin and stays with you 24 hours a day, then perhaps it's not a bad idea, but you still have to know where it is and you have to have someone around who can use it on you. Complicated story. I hope it makes a bit of sense. If you have any queries or questions about this, please let me know. And if you've got any ideas for any other topics like this, please also let me know. For now. I wish you the best. You have been listening to another podcast from Dr Warrick. Visit his website at drWarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.
