VIDEO: ICDs cut mortality in younger, healthier heart failure patients

The message from this study is that in younger, nonischemic heart failure patients at risk for sudden cardiac death but with relatively less morbidity and more life expectancy, the placement of an implantable cardioverter-defibrillator produced a substantial reduction in all-cause mortality.

Although the all-cause mortality benefit was not statistically significant in the entire study population, the study results were very consistent with what we know about sudden cardiac death and why we give ICD therapy to heart failure patients. In DANISH the ICDs did what they are supposed to do, which is prevent sudden cardiac death.

The guidelines say that ICD treatment is appropriate when a patient’s life expectancy is “substantially” more than 1 year. They don’t specify an age cutoff because some 80-year-olds can have a good life expectancy while some younger patients may have comorbidities that make them unlikely to live more than 6 months. ICDs should be targeted to patients at high enough risk from sudden cardiac death to potentially get benefit from the device but not so high-risk that an ICD would be unlikely to make a difference in survival.

Many heart failure patients who could potentially get a benefit from an ICD still do not receive them. ICDs remain an underused treatment for heart failure patients in U.S. practice including patients with nonischemic systolic heart failure.

Javed Butler, MD, is a professor of medicine and chief of cardiology at Stony Brook (N.Y.) University. He made these comments in an interview. He has been a consultant to several drug and therapeutics companies but had no relevant disclosures.