It takes a community to save a life in cardiac arrest: Heart safe community pilots, Australia.

ISSUE ADDRESSED: In Australia only 1 in 12 people will survive an out of hospital cardiac arrest (OHCA). Heart Safe Community (HSC) is a public health initiative being implemented by the Heart Foundation, Victoria in partnership with Ambulance Victoria. It aims to improve survival from OHCA by improving public access to 24 hours Automated External Defibrillators (AEDs) and by building local community skills and confidence in basic resuscitation. Over the period 2017-20, the University of Melbourne was commissioned to evaluate the implementation, effectiveness, and sustainability of three HSC pilots in Victoria, Australia. METHODS: Mixed methods were used including eight focus group discussions with 64 local HSC community stakeholders and local HSC pilot site evaluation data. RESULTS: The local HSC pilot community presentation surveys revealed that the HSC pilots delivered hundreds of presentations on bystander resuscitation, with 2772 local community members being exposed to the call to action: 'Call, Push Shock' and 'anyone can save a life'. Focus group discussions revealed that the HSC pilots built local community capacity to respond to OHCA as demonstrated by increased knowledge, confidence and skills to call Emergency Medical Services, attempt chest compression, acquire and use an AED. Community leadership to advocate for improved access to AEDs and to propagate HSC initiatives amongst community settings and cohorts has occurred. HSC implementation enablers and challenges exist. Community capacity-building frameworks can explain what makes the HSC pilot work. CONCLUSION: HSC can build local community capacity to respond to OHCA. Eight principles are suggested to support the building, implementation and sustainability of future HSC efforts. SO WHAT?: The HSC experience reveals that community members across the lifespan and multiple settings embrace opportunities to improve the safety and response in their community to a cardiac arrest when the action is simplified and community ownership cultivated.

Implantable cardioverter defibrillator knowledge and end-of-life device deactivation: A cross-sectional survey.

BACKGROUND: End-of-life implantable cardioverter defibrillator deactivation discussions should commence before device implantation and be ongoing, yet many implantable cardioverter defibrillators remain active in patients' last days. AIM: To examine associations among implantable cardioverter defibrillator knowledge, patient characteristics and attitudes to implantable cardioverter defibrillator deactivation. DESIGN: Cross-sectional survey using the Experiences, Attitudes and Knowledge of End-of-Life Issues in Implantable Cardioverter Defibrillator Patients Questionnaire. Participants were classified as insufficient or sufficient implantable cardioverter defibrillator knowledge and the two groups were compared. SETTING/PARTICIPANTS: Implantable cardioverter defibrillator recipients ( n = 270, mean age 61 ± 14 years; 73% male) were recruited from cardiology and implantable cardioverter defibrillator clinics attached to two tertiary hospitals in Melbourne, Australia, and two in Kentucky, the United States. RESULTS: Participants with insufficient implantable cardioverter defibrillator knowledge ( n = 77, 29%) were significantly older (mean age 66 vs 60 years, p = 0.001), less likely to be Caucasian (77% vs 87%, p = 0.047), less likely to have received implantable cardioverter defibrillator shocks (26% vs 40%, p = 0.031), and more likely to have indications of mild cognitive impairment (Montreal Cognitive Assessment score <24: 44% vs 16%, p < 0.001). Insufficient implantable cardioverter defibrillator knowledge was associated with attitudes suggesting unwillingness to discuss implantable cardioverter defibrillator deactivation, even during the last days towards end of life ( p < 0.05). CONCLUSION: Implantable cardioverter defibrillator recipients, especially those who are older or have mild cognitive impairment, often have limited knowledge about implantable cardioverter defibrillator deactivation. This study identified several potential teachable moments throughout the patients' treatment trajectory. An interdisciplinary approach is required to ensure that discussions about implantable cardioverter defibrillator deactivation issues are initiated at appropriate time points, with family members ideally also included.