MADIT II/SCD-HeFT Results: Have They Already Achieved an Impact in Europe?

Conclusions

The MADIT II study and the SCD-HeFT studies suggest that the ICD reduces total mortality in patients with patients with LV dysfunction. However, the cost-effectiveness of this treatment makes it far from affordable. Better selection of patients that could benefit from an ICD might increase the cost-effectiveness and decrease the percentage of patients in whom an ICD will only produce inappropriate discharges and other undesirable effects. Subgroup analysis has demonstrated a progressive increase in effectiveness of the ICD as QRS duration increases. Little benefit was derived in patients with a QRS of less than 0.12 s, whereas if a QRS duration of 0.15 s was used as a cut-off, a marked reduction in SCD was observed, comparable to that in MUSTT and MADIT I. Similarly, in the SCD-HeFT trial the relative benefits of ICD therapy appeared greater in patients with NYHA class II heart failure, the group in which sudden death is expected to predominate. There seemed to be no benefit in patients with NYHA class III heart failure.