Primary prevention of SCD: a guide to the guidelines

  • Beaser AD & al.
  • JAMA
  • 13 Jun 2019

  • International Clinical Digest
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Takeaway

  • 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.

Key recommendations

  • With reduced EF ( 
    • β-blockers; 
    • 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.