Key result
Implantable cardioverter defibrillators did not show a benefit in the DANISH trial, likely due to high rates of optimal medical therapy (97% ACE/ARB, 92% beta-blockers) and CRT use (58%).
The lack of ICD benefit in recent trials like DANISH may be explained by improvements in background medical and resynchronization therapies.
here have been multiple randomized control trials of implantable cardioverter defibrillators (ICDs) in various patient populations over the last 20 years. Earlier trials showed a relatively convincing benefit with ICDs. 1,2 However, the DANISH trial (Danish Study to Assess the Efficacy of ICDs in Patients With Non-Ischemic Systolic Heart Failure), which randomized patients from years 2008 to 2014, did not show such a benefit. 3 It has been argued (I think rightfully so) that this is because of the improvement in medical therapy and cardiac resynchronization therapy (CRT) over the years. Indeed, optimal guideline-directed medical therapy (97% ACE [angiotensin-converting enzyme] or ARB [angiotensin-receptor blocker]; 92% beta-blockade) and CRT use (58%) were quite high in the Danish trial.
No takes yet. Share an insight, caveat, or question.
Mark S. Link (2022) conducted an editorial in Non-Ischemic Systolic Heart Failure. Implantable cardioverter defibrillators (ICDs) was evaluated. Implantable cardioverter defibrillators did not show a benefit in the DANISH trial, likely due to high rates of optimal medical therapy (97% ACE/ARB, 92% beta-blockers) and CRT use (58%).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: