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ICD Use in the Under-Represented

ICD Use in the Under-Represented

Implantable cardioverter-defibrillators (ICDs) have emerged as an important treatment option for select patients with heart failure, those with reduced left ventricular function, and individuals at risk for cardiac arrest or sudden cardiac death. “For years, these devices have served as an effective means of stopping life-threatening abnormal heart rhythms,” explains Venu Menon, MD. Recommendations on ICD use in clinical practice have been provided in guidelines sponsored by the American College of Cardiology (ACC), the American Heart Association (AHA), Heart Rhythm Society (HRS), and the European Society of Cardiology. However, recent guideline updates are lacking because most clinical trials tend to focus on the effectiveness of ICDs that provide cardiac resynchronization therapy (CRT) rather than outcomes of non-CRT defibrillators. “Although many patients have benefited from ICD implants, there are still groups who fall outside the standard guidelines for treatment,” says Dr. Menon. Smaller patient populations or unique circumstances are not typically provided with indications for treatment. As a result, guideline indications for ICD therapy are limited specifically to patients who would have been eligible for enrollment in clinical trials. “Clinicians are often asked to make decisions about ICD therapy for patients who were not included or who were poorly represented in prior clinical trials,” Dr. Menon says. “For these individuals, there are no specific indications for ICD therapy.” Addressing an Important Need In 2014, the ACC, HRS, and AHA released an expert consensus statement, published in the Journal of the American College of Cardiology, on ICD use in patients not included or not well represented in clinical trials. “The statement provides direction on ICD therapy that specifically targets patients who...
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