- JAMA offers a synopsis for clinicians navigating primary prevention of sudden cardiac death (SCD) in high-risk populations, highlighting key recommendations, changes from previous guidelines, and patient benefits.
- The synopsis covers the 2018 release of the latest guidelines .
Why this matters
- SCD underlies half of all cardiovascular death, with risks increased for patients with compromised ejection fraction (EF), heart failure, prior cardiac arrest, or coronary artery disease.
- With reduced EF (
- Mineralocorticoid receptor antagonists; and
- Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor-neprilysin inhibitors.
- With life expectancy >1 year, where GDMT fails to prevent the following, implanted cardioverter defibrillator (ICD) is recommended:
- Left ventricular EF (LVEF) ≤35% and ischemic heart disease at 40+ days after myocardial infarction, 90+ days postrevascularization, class II-III heart failure;
- LVEF ≤30% with ischemic heart disease at 40+ days after myocardial infarction, 90+ days postrevascularization, class I heart failure; or
- Nonischemic cardiomyopathy, class II-III symptoms, LVEF ≤35%.
- Biggest guidelines change from earlier versions is addition of angiotensin receptor-neprilysin inhibitors, which the synopsis authors say remains controversial.
- Benefits for patients include the focus on GDMT before moving to ICD, with parameter of expected survival >1 year.