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Targeted ICD selection based on predicted therapy benefit enhances patient outcomes while cutting hospital costs by 16.7%. 

The study published in the June 2025 issue of Clinical Research in Cardiology required a strong need to improve the selection of individuals with reduced left ventricular ejection fraction for primary prevention of sudden cardiac death through implantable cardioverter-defibrillator (ICD) placement.  

Researchers conducted a retrospective study to estimate the clinical and economic benefits of stricter indication scenarios based on minimum probabilities of appropriate ICD therapy which requires surgical invasion and maximum risks of early mortality within 2 years post-implantation.  

They collected clinical event data and hospital care expenditures from individuals enrolled in the Dutch DO-IT registry. Registry-based prediction models were applied to estimate individual prior probabilities. Assumptions were made regarding short-term disease progression and related hospital care in the absence of ICD implantation. The effect of stricter indication scenarios was evaluated by changes in numbers needed to treat (NNT) within subgroups identified for ICD implantation (NNT-yes) and those without indication (NNT-no), along with estimated changes in the annual incidence-based national hospital care budget for ICD-based primary prevention.  

The results showed that the individuals of NNT meeting current guidelines (NNT-yes) were 42. Applying a threshold where ICD implantation was not recommended for those with less than 5% probability of receiving appropriate therapy within 2 years post-implant yielded an NNT-yes of 33 and an NNT-no of 246. This approach was linked to an annual national reduction in hospital care costs for ICD-based primary prevention of €11 million (16.7%).  

Investigators concluded that stricter indication criteria for primary prevention of ICD implantation enabled the identification of subpopulations with high numbers needed to treat, reducing unnecessary harm and achieving significant cost savings. 

Source: link.springer.com/article/10.1007/s00392-025-02687-4