Implantable cardioverter/defibrillators in the primary prevention of sudden death: we know what to do but are we doing it?

摘要

The mandate to weigh risks and benefits for use of cardiac rhythm devices (specifically implant-able cardioverter/defibrillators [ICDs]) for the primary prevention of sudden cardiac death is substantial, given the cost of the devices and their potential impact on patient outcomes including health-related quality of life. Recent studies have demonstrated that comorbidi-ties such as renal failure, underuse of beta-blockers, and inappropriate timing of implants are all in play. In their analysis, Miller and colleagues use data from the National Cardiovascular Data Registry (NCDR) to assess whether patients undergoing device implantation with reduced ejection fraction are receiving optimal medical therapy (OMT) for congestive heart failure.