Health officials in Great Britain have begun the placement of automatic external defibrillators (AEDs) in public facilities throughout the country in an effort to curb deaths from heart attacks. The British Heart Foundation reports 140,000 fatalities in Britain each year from coronary heart disease, making it the country's No. 1 cause of death.

More than 700 of the AEDs will be placed in railway stations, shopping centers, airports, and bus stations over the next year, reported Public Health Minister Yvette Cooper. She said that the purpose was to decrease the odds of dying from a heart attack, with only three out of every hundred surviving such an event in Britain. "We need to improve that rate," she said. The project, considered a first in Europe, will cost 2 million pounds.

The first defibrillator was unveiled by Cooper at the MetroCentre shopping complex in Gateshead in northern England, and about 90 MetroCentre staff have been trained to use the devices which have an automated protection system. The AEDs will be installed at London's mainline railway stations in the next few weeks, and Heathrow Airport is scheduled to receive its units over the summer.

... and legislation pending in U.S.

Legislation that would allow Secretary of Health and Human Services Donna Shalala to recommend the distribution of defibrillators in federal and other public office buildings has passed in the U.S. Senate. The Cardiac Arrest Survival Act, sponsored by Sen. Slade Gorton (R-Washington) in April was awaiting consideration in the House. The bill includes recommendations for operating programs for public access to defibrillators. "Public access to defibrillation is definitely one of our main goals and objectives," said Brian Henry, an American Heart Association (AHA; Dallas, Texas) spokesman. Nearly 250,000 people die each year from sudden cardiac arrest in the U.S., according to the AHA, which says passage of the bill could save up to 50,000 lives a year.

In related news, mall developer General Growth Properties (GGP; Chicago, Illinois) said last month that it plans to equip all of its 136 U.S. malls with Heartstream ForeRunner AEDs made by Agilent Technologies (Palo Alto, California). GGP pointed to a national study showing that shopping malls rank third – behind airports and county jails – among the top five sites where sudden cardiac arrest occurs. The mall developer said it has committed to purchasing approximately 290 AEDs, with each mall to get at least two of the devices.

HMOs putting NY bypass patients at risk?

A new study focusing on heart bypass surgery outcomes in the state of New York indicates that heart bypass surgery patients in that state receive different treatment in terms of the hospitals they are sent to. Those covered by managed care plans undergo the procedure at hospitals defined as having higher death rates; in comparison, those covered by traditional fee-for-service plans are more frequently treated at hospitals with lower death rates, according to the report published in the April 19 Journal of the American Medical Association. A research team led by Lars Erickson, MD, of Children's Hospital (Boston, Massachusetts) examined the records for nearly 49,000 patients who had bypass surgery in 31 New York hospitals from 1993 to 1996, the information gathered from an extensive databank maintained by the state. Fourteen hospitals were classified as having low mortality rates, averaging 2.1% after the surgery; 17 had rates of 3.2% and were classified as higher mortality.

Analysis of the data showed that those covered by private managed care companies were 23% less likely to undergo the procedure at one of the lower-mortality hospitals in comparison to those covered by private fee-for-service plans. Patients covered by Medicare also were less likely – by 39% – to be treated at a lower-mortality hospital. These figures seemed significantly related to the fact that the lower-mortality hospitals often were not included on an HMO's list of providers. Erickson said that the current results should not be generalized to other states, noting that a similar study for California had drawn the opposite conclusion: that patients covered by managed care in that state more often had cardiac bypass procedures at low-mortality hospitals.

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