Sudden Death Prevention

JAMA Clinical Guidelines Synopsis 

June 13, 2019 Download PDF

Primary Prevention of Sudden Cardiac Death

Andrew D. Beaser, MD¹; Adam S. Cifu, MD¹; Hemal M. Nayak, MD¹

Major recommendations

• In patients with heart failure with reduced ejection fraction (<40 a="" all-cause="" and="" angiotensin-converting="" angiotensin="" antagonists="" blockers="" cardiac="" class="" death="" enzyme="" gdmt="" guideline-directed="" i="" includes="" inhibitors="" is="" level="" medical="" mineralocorticoid="" mortality="" neprilysin="" or="" p="" receptor="" recommendation="" recommended="" reduce="" sudden="" therapy="" to="">
• In patients with left ventricular ejection fraction (LVEF) of 35% or less due to ischemic heart disease at least 40 days after myocardial infarction, at least 90 days after revascularization, and with New York Heart Association (NYHA) class II or III heart failure despite GDMT, an ICD is recommended if expected survival is greater than 1 year (class I, level A recommendation).
• In patients with LVEF of 30% or less due to ischemic heart disease at least 40 days after myocardial infarction, at least 90 days after revascularization, and with NYHA class I heart failure symptoms despite GDMT, an ICD is recommended if expected survival is greater than 1 year (class I, level A recommendation).
• In patients with nonischemic cardiomyopathy, NYHA class II to III symptoms, and LVEF of 35% or less despite GDMT, an ICD is recommended if expected survival is greater than 1 year (class I, level A recommendation).