Implantable cardioverter-defibrillators (ICDs) are recommended to reduce the risk of sudden cardiac death (SCD) in patients with heart failure with reduced ejection fraction (HFrEF). The landmark studies leading to the current guideline recommendations preceded the 4 pillars of guideline-directed medical therapies (GDMTs). Therefore, some have questioned the role of ICDs for primary prevention in current clinical practice. In this paper, the authors provide an overview of the current ICD recommendations, including the instrumental clinical trials, the risk of SCD as observed in clinical trials vs real-world scenarios, disparities in ICD use among different patient populations, the impact of contemporary GDMT on outcomes, and ongoing and future trials and methodologies to help identify patients who are at an increased risk of SCD and who may benefit from an ICD. The authors also propose a pragmatic guidance for clinicians when they engage in the shared decision-making discussions for primary ICD implantation.

中文翻译：

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重新审视 ICD 治疗对射血分数降低的心力衰竭患者的一级预防


建议使用植入式心律转复除颤器 （ICD） 以降低射血分数降低 （HFrEF） 心力衰竭患者发生心源性猝死 （SCD） 的风险。导致当前指南建议的里程碑式研究先于指南导向的药物治疗 （GDMT） 的 4 大支柱。因此，一些人质疑 ICD 在当前临床实践中对一级预防的作用。在本文中，作者概述了当前的 ICD 建议，包括工具性临床试验、临床试验与真实场景中观察到的 SCD 风险、不同患者群体之间 ICD 使用的差异、当代 GDMT 对结果的影响，以及正在进行和未来的试验和方法，以帮助识别 SCD 风险增加的患者以及可能从 ICD 中受益的患者。作者还为临床医生在参与原发性 ICD 植入的共同决策讨论时提出了一个务实的指导。