title: Rationale and design of the Home Automatic External Defibrillator Trial (HAT).
abstract: Most cardiac arrests occur in the home, where emergency medical services (EMS) systems are challenged to provide timely care. Because a large proportion of sudden cardiac arrests (SCAs) are due to ventricular tachycardia or ventricular fibrillation, home use of an automated external defibrillator (AED) might offer an opportunity to decrease mortality in those at risk. Predicting who will have a cardiac arrest in the general population is difficult. Individuals at high risk are usually easily identified and may become candidates for implantable cardioverter defibrillators. It is within the population at lower risk where home AEDs may be most useful. The purpose of the Home Automatic External Defibrillator Trial (HAT) is to test whether providing home access to an AED can improve survival in patients at modest risk of SCA, such as those surviving an anterior myocardial infarction but in whom implantable cardioverter defibrillator therapy is not deemed necessary. Between January 23, 2003, and October 20, 2005, 7001 patients were enrolled, with completion of follow-up scheduled for September 30, 2007. Randomization was conducted in a 1:1 fashion between control therapy, comprising the standard lay response to SCA (calling the EMS and performing cardiopulmonary resuscitation), and the use of an AED first, followed by calling the EMS and performing cardiopulmonary resuscitation. The primary end point is all-cause mortality. Secondary outcomes include survival from SCA (witnessed and unwitnessed, in home and out of home), incremental cost-effectiveness, and quality of life measures for both the patient and the spouse/companion. The results of the trial should be available in mid 2008.
authors.affiliation: The Seattle Institute for Cardiac Research, Seattle, WA 98103-4819, USA. gbardy@sicr.org
authors.forename: Gust H
authors.initials: GH
authors.lastname: Bardy
authors.forename: Kerry L
authors.initials: KL
authors.lastname: Lee
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Mark
authors.forename: Jeanne E
authors.initials: JE
authors.lastname: Poole
authors.forename: William D
authors.initials: WD
authors.lastname: Toff
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Tonkin
authors.forename: Warren
authors.initials: W
authors.lastname: Smith
authors.forename: Paul
authors.initials: P
authors.lastname: Dorian
authors.forename: Julie J
authors.initials: JJ
authors.lastname: Yallop
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Packer
authors.forename: Roger D
authors.initials: RD
authors.lastname: White
authors.forename: Will
authors.initials: W
authors.lastname: Longstreth
authors.forename: Jill
authors.initials: J
authors.lastname: Anderson
authors.forename: George
authors.initials: G
authors.lastname: Johnson
authors.forename: Eric
authors.initials: E
authors.lastname: Bischoff
authors.forename: Crystal D
authors.initials: CD
authors.lastname: Munkers
authors.forename: Amanda
authors.initials: A
authors.lastname: Brown
authors.forename: Steven
authors.initials: S
authors.lastname: McNulty
authors.forename: Linda Davidson
authors.initials: LD
authors.lastname: Ray
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Clapp-Channing
authors.forename: Yves
authors.initials: Y
authors.lastname: Rosenberg
authors.forename: Marcel
authors.initials: M
authors.lastname: Salive
authors.forename: Eleanor B
authors.initials: EB
authors.lastname: Schron
mesh_terms: D003362:Cost-Benefit Analysis; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D004554:Electric Countershock / Q000191:economics / Q000379:methods*; D005500:Follow-Up Studies; D006699:Home Care Services / Q000191:economics / Q000592:standards*; D006801:Humans; D015337:Multicenter Studies as Topic / Q000379:methods*; D010353:Patient Education as Topic; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D017180:Tachycardia, Ventricular / Q000150:complications / Q000628:therapy*