Quality of life in heart failure and implantable cardioverter defibrillator patients: time to close the gap in holistic care

This invited editorial refers to ‘Quality of life in patients with heart failure and implantable cardioverter defibrillator: results from 9274 patients in 42 outpatient heart failure clinics in the National Norwegian Heart Failure Registry’, by H. Flagtvedt et al., https://doi.org/10.1093/ehjqcco/qcaf062. In the era of precision cardiology, implantable cardioverter defibrillators (ICDs) remain a cornerstone of sudden cardiac death prevention in selected patients with heart failure with reduced ejection fraction (HFrEF).1 However, the story of ICDs extends beyond mortality benefit—it intersects with lived patient experiences, psychological burden, and quality of life (QoL). In this issue of the European Heart Journal – Quality of Care and Clinical Outcomes, Flagtvedt et al.2 present a comprehensive analysis of QoL trajectories in 9274 patients from the National Norwegian Heart Failure Registry, including 1206 patients with ICDs, across 42 outpatient heart failure clinics. Analysing data from over 9000 patients within the National Norwegian Heart Failure Registry, including more than 1200 ICD recipients, the authors report a key finding: while QoL improves over time in both groups after follow-up in structured HF clinics, the degree of improvement is significantly less in those with ICDs. This nuanced observation brings to the fore a critical and often underappreciated aspect of HF management—the unique psychological and functional challenges faced by patients living with ICDs.