ICD Implantation in Patients with Nonischemic Heart Failure

To the Editor: The findings of the Danish Study to Assess the Efficacy of ICDs [Implantable Cardioverter–Defibrillators] in Patients with Non-ischemic Systolic Heart Failure on Mortality (DANISH) (Sept. 29 issue) 1 are important and raise doubts about the current strategy of defibrillator implantation for the primary prevention of sudden cardiac death. The results are not unexpected. Current recommendations are based mainly on the Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II) 2 and the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). 3 Since these trials were conducted, the treatment of patients with heart failure has changed dramatically, with the introduction of angiotensin receptor–neprilysin . . .