Optimizing the Primary Prevention of Sudden Cardiac Death in Patients with Heart Failure (JACC July 2025-2)-Article: Optimizing the Primary Prevention of Sudden Cardiac Death in Patients with Heart Failure

Article: Optimizing the Primary Prevention of Sudden Cardiac Death in Patients with Heart Failure

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The document is a state-of-the-art review from the Journal of the American College of Cardiology, detailing recommended strategies for improving the primary prevention of sudden cardiac death (SCD) in heart failure (HF) patients. It focuses on the current role and future potential of implantable cardioverter-defibrillators (ICDs). Traditionally, ICDs are implanted based on reduced left ventricular ejection fraction (LVEF), as LVEF is a strong predictor of SCD. However, advancements in the medical management of HF have lowered SCD risk among patients with reduced LVEF, resulting in many ICDs being implanted without necessity. Conversely, ICDs are not recommended for HF patients with preserved LVEF, who still face a high risk of SCD.<br /><br />The review argues that reliance on LVEF is problematic due to its variability and the need for more comprehensive prediction models. It highlights advances like artificial intelligence (AI) and machine learning, which could improve risk stratification by processing diagnostic data (such as from ECG or CMR imaging) to better match patient risk with appropriate ICD use. The review discusses ongoing clinical trials that may reshape ICD guidelines by better identifying high-risk individuals who would benefit from ICDs.<br /><br />The analysis concludes with a call for new, dynamic risk prediction models adjusted for contemporary HF treatments. These models could ultimately guide more effective ICD use, protecting those at true risk of SCD while avoiding unnecessary device complications and healthcare costs. The recent decline in SCD rates due to improved HF management underscores the need for updated ICD use guidelines to align with the evolving healthcare landscape.

Keywords

sudden cardiac death

heart failure

implantable cardioverter-defibrillators

left ventricular ejection fraction

risk stratification

artificial intelligence

machine learning

clinical trials

prediction models

healthcare costs