TOPLINE:

According to a large US cohort study, the use of automated external defibrillators (AEDs) in private homes was associated with a 26% increase in survival in patients with cardiac arrest with shockable rhythms, but at more than $4.48 million per quality-adjusted life-year gained, they were not found cost-effective at current prices.

METHODOLOGY:

• Researchers conducted an observational cohort study using data of 582,536 patients (median age, 65 years; 61.8% men; 50.5% White individuals) with nontraumatic out-of-hospital cardiac arrests that occurred in private homes, recorded in the Cardiac Arrest Registry to Enhance Survival system between 2017 and 2024.
• Survival outcomes were compared between patients who had an AED attached by a bystander prior to the arrival of emergency medical services and those who did not have an AED attached. Only 0.1% of patients had an AED applied, and 16.1% had an initial shockable rhythm.
• Cost-effectiveness was evaluated from societal and healthcare payer perspectives, using quality-adjusted life-years as the measure of effectiveness.
• The primary outcome was survival to hospital discharge, and secondary outcomes included return of spontaneous circulation, hospital admission, and favorable neurologic outcome (defined as survival with Cerebral Performance Category scores of 1 or 2), and the incremental cost-effectiveness ratio of home AED ownership.

TAKEAWAY:

• The use vs nonuse of AED was linked to a 26% increase in survival to hospital discharge in patients with shockable rhythm (risk ratio [RR], 1.26; 95% CI, 1.01-1.57) but showed no benefit in those with nonshockable rhythms (RR, 1.00; 95% CI, 0.68-1.46). Similarly, in an adjusted difference-in-differences analysis, the use of AED was associated with an increase in survival to hospital discharge (RR, 1.26; 95% CI, 0.82-1.95).
• In patients with shockable rhythms, the use of AED was linked to increased rates of return of spontaneous circulation (46.5% vs 42.1%; RR, 1.06), hospital admission (47.8% vs 41.4%; RR, 1.15), and favorable neurologic outcome at discharge (25.2% vs 18.3%; RR, 1.33). However, no benefit was observed in patients with nonshockable rhythms.
• The incremental cost-effectiveness ratio for an AED in a private home was $4,481,659 per quality-adjusted life-year gained.
• At a threshold of $200,000 per quality-adjusted life-year gained , AEDs would become cost-effective only if the annual incidence of cardiac arrest exceeded 1.3% or if the device cost fell below $65 (excluding bystander training cost) with an 8-year lifespan.

IN PRACTICE:

"In this cohort study, we found that AEDs in private homes are effective at improving outcomes for patients with cardiac arrest with a shockable rhythm. The indiscriminate purchase of AEDs for individual private homes cannot be considered cost-effective at the current pricing of AEDs," the authors wrote.

SOURCE:

The study was led by Lars W. Andersen, MD, MPH, PhD, DMSc, Aarhus University, Aarhus, Denmark. It was published online on October 25 in JAMA Internal Medicine.

LIMITATIONS:

The study was limited by its observational design and several underlying assumptions that could not be definitively proven. The sample size was restricted due to the rarity of the use of AEDs in private homes, resulting in imprecise primary estimates with wide CIs. Data were confined to cardiac arrests occurring in private homes, excluding public locations, and lacked detailed information on comorbidities, AED placement, and bystander training. Additionally, the cost-effectiveness analysis was based on model assumptions that may not have fully reflected real-world variations in the risk for cardiac arrest, AED costs, or long-term outcomes, limiting the generalizability of the findings.

DISCLOSURES:

Funding information was not provided for this study. Several authors reported having financial ties with various sources. Details are provided in the original article. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.