Feeling lucky? Heart patients at risk for sudden cardiac arrest must ask themselves that question when they're being discharged from the hospital with a prescription in their hands instead of a defibrillator in their chests.
SCA takes the lives of 250,000 Americans each year, usually because an abnormal heart rhythm causes the heart to suddenly stop beating.
Some high-risk arrhythmia patients have a mini defibrillator implanted in their chest to constantly monitor the heart and deliver a shock when needed.
But you can't get one implanted immediately; first doctors must determine whether the surgery will be safe for you, and whether medication might do the job at lower risk and lower cost. The waiting period can mean an anxious 40 to 90 days, when a patient might wonder if he'll have another episode, and whether help in the form of an external defibrillator will arrive in time.
Now doctors can send high-risk patients home with a defibrillator they can strap to their chest, and which automatically activates when needed.
"Before we had this device, a certain percentage of patients died of cardiac arrest while waiting for an implant," said Bayfront Medical Center interventional cardiologist Jason C. Levine.
That could have happened to one of Levine's patients.
Jeff Brown, a Missouri travel agent who has a vacation home in St. Petersburg, had a heart attack during a recent visit. Deemed at high risk of SCA, Levine discharged him from the hospital with a Zoll LifeVest that he would wear at all times, except while bathing.
Worn under clothing, it has chest and shoulder straps with therapy pads pressed to the skin, one in front, two in back. A heart monitor about the size of a paperback book is hooked to a belt or hung from a shoulder strap. If the monitor detects an abnormal heartbeat, the pads release a protective blue gel and deliver a shock to the heart. Alarms and a voice track indicate when the vest goes into action.
Three days after leaving the hospital, Brown blacked out. He awoke to hear the vest telling him it had given his heart the necessary electrical shock, and to contact his doctor.
A sudden, abnormal heartbeat triggered the device and in less than a minute, it shocked his heart back into rhythm.
"He was essentially, you hate to say it, but dead, in cardiac arrest, when it fired," said Levine. "I'm pretty confident that he would not have survived without the vest."
Dr. Vasco Marques, an interventional cardiologist at Pepin Heart Hospital at University Community Hospital in Tampa, has prescribed LifeVest for 15 to 20 patients in the past three years.
Marques estimates that after the medication trial period, doctors find 30 to 40 percent of patients don't need an implant. "They can be treated medically, which saves them from unnecessary surgery and saves about $50,000 in health care costs."
LifeVest also may be prescribed after a heart attack, bypass surgery or stent placement; when a patient has congestive heart failure; or while waiting for a heart transplant. Patients wear the vests three months on average; most insurers cover the $3,000 monthly rental cost.
Dr. Siva Kumar, a heart transplant surgeon at Tampa General Hospital, said his practice sends two to three patients a month home with a LifeVest.
"No one wants to go around with a device in their chest if they don't have to," he said. "This is like an insurance policy."
Two of Kumar's patients have been saved by LifeVest. Marques has one. Jeff Brown is Levine's first. "It was a big save," said Levine. "He's just 39. So we were really excited about it."
So is Brown, who is now back home in Missouri, after having a permanent defibrillator implanted at Bayfront on June 13.
"It's a silly-looking thing," he said. "But it's pretty cool."
Irene Maher may be reached at firstname.lastname@example.org