Guideline-Directed Medical Therapy and the Risk of Death in Primary Prevention Defibrillator Recipients

Far From Simple: The Search for a Universal Cardiac Resynchronization Programming Algorithm

“…Drugs including angiotensin receptor/neprilysin inhibitors and SGLT2 (sodium-glucose cotransporter 2) inhibitors show incredible promise and might affect recommendations for defibrillator and CRT implantation in the future. 20 The results of the SMART-CRT trial show that our understanding of how to best optimize CRT remains incomplete. Despite trials of AV and VV optimization, manufacturers continue to search for an ideal pacing mode or algorithm.…”

“…Drugs including angiotensin receptor/neprilysin inhibitors and SGLT2 (sodium-glucose cotransporter 2) inhibitors show incredible promise and might affect recommendations for defibrillator and CRT implantation in the future. 20…”

Time to rechallenge primary prevention ICD guidelines

“…Recent observational evidence demonstrates that patients who receive guideline-directed medical therapy have an almost fourfold reduction in risk of death at 2 years compared with those not on therapy, conferring a 34% reduction in risk of death for each drug added in patients who have an ICD implanted. 8 Current ESC guidelines 9 recommend ICD implantation with a Class 1a indication, in those with ischaemic HF with an LVEF <35% despite optimal medical therapy (OMT) for ≥3 months, symptoms (NYHA II/III), a QRS < 130 ms, and a life expectancy of at least 1 year. Considering there have been no new ICD trials in ischaemic HF since SCD-HeFT, 10 published in 2005, these recommendations seem outdated.…”

“…Ca 2+ regulation, late Na + and Na + /hydrogen‐exchanger currents), 7 which may similarly contribute to their anti‐arrhythmic properties outside of their ability to improve left ventricular ejection fraction (LVEF). Recent observational evidence demonstrates that patients who receive guideline‐directed medical therapy have an almost fourfold reduction in risk of death at 2 years compared with those not on therapy, conferring a 34% reduction in risk of death for each drug added in patients who have an ICD implanted 8 …”

Sequencing of medical therapy in heart failure with a reduced ejection fraction

“…Concerning is the fact that potential gains from a drug agent may be lost the longer it takes to be initiated in the HF syndrome with one study estimating an absolute mortality risk of 1% per month in suboptimally treated patients 34. In HF patients with primary prevention cardioverter defibrillator implanted, each additional GDMT prescribed reduced the risk of death by 36% 35. Patient factors are important contributors to treatment inertia.…”