Effectiveness of Implantable Cardioverter-Defibrillator Therapy for Primary Prevention in Patients with Nonischemic Heart Failure with Reduced Ejection Fraction.
Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: BACKGROUND: Primary prevention with an implantable cardioverter-defibrillator (ICD) has become an increasingly debated strategy, with its role in patients with nonischemic heart failure with reduced ejection fraction (HFrEF) undergoing continued reassessment. OBJECTIVE: To summarize the available scientific evidence on the effectiveness of ICD therapy for primary prevention in patients with nonischemic HFrEF. METHODS: A rapid systematic review and meta-analysis was conducted in accordance with the recommendations of the Cochrane Rapid Reviews Methods Group and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Statistical significance was defined as a two-sided p-value < 0.05. Searches were performed in the MEDLINE, Embase, and CENTRAL databases. Randomized controlled trials (RCTs) evaluating ICD implantation for primary prevention were included, with sudden cardiac death (SCD), cardiovascular mortality, and all-cause mortality as the primary outcomes. RESULTS: A total of 18 publications reporting daata from six pivotal RCTs were included. ICD therapy was associated with a statistically significant reduction in SCD (relative risk [RR] 0.41; 95%CI 0.26-0.65; high-certainty evidence) and cardiovascular mortality (RR 0.75; 95%CI 0.59-0.95; high-certainty evidence). For all-cause mortality, the primary analysis showed no statistically significant difference between groups (RR 0.88; 95%CI 0.72-1.07; moderate-certainty evidence). In the subgroup analysis, studies with shorter follow-up (< 6.8 years) demonstrated a significant reduction in all-cause mortality (RR 0.69; 95%CI 0.52-0.92). CONCLUSION: In patients with nonischemic HFrEF, ICD therapy reduced SCD and cardiovascular mortality but did not significantly reduce all-cause mortality in the primary analysis. These findings support the use of ICD therapy when guided by individualized clinical assessment.
Source: PubMed Central
Institutions: Hospital Moinhos de Vento, Hospital de Clínicas de Porto Alegre, Pontifícia Universidade Católica do Paraná, Hospital Universitário Cajuru, Santa Casa Hospital, Universidade Luterana do Brasil, Universidade de Pernambuco, Hospital Sírio-Libanês, Fundação Universitária de Cardiologia, Hospital Universitário da Universidade Federal do Maranhão, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto do Coração - HCFMUSP, Universidade do Estado do Rio de Janeiro, D’Or Institute for Research and Education, Universidade de São Paulo, Clinics Hospital of Ribeirão Preto
Language: Portuguese
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7222873724