Implantable Cardioverter Defibrillators for Primary Prevention of Sudden Cardiac Death: Too Little and Too Late?
The implantable cardioverter defibrillator (ICD) has been one of the most significant advances made in sudden cardiac death (SCD) prevention. Landmark randomized clinical trials convincingly demonstrated survival benefits of ICD therapy in patients 40 days after myocardial infarction (MI) with left ventricular ejection fraction (LVEF) of less than 30%1 and in patients with stable New York Heart Association Class II-III CHF and LVEF of less than 35%2, and subsequent observational studies have confirmed these mortality benefits3. Results from clinical trials were rapidly incorporated into guidelines4, 5, and the centers for Medicaid and Medicare services (CMS) approved both indications for primary prevention ICDs by 2005. At the same time, CMS mandated that data on all patients receiving ICDs be entered into a national registry to track utilization. Approximately 10 years later, what progress have we made with respect to allocating and disseminating this life-saving technology and what further impact can be made with this technology on mortality due to SCD? The article by Chugh et al in this issue of Circulation highlights these questions6.
- Received September 12, 2013.
- Accepted September 13, 2013.