Yafasova A, Butt JH, Elming MB, et al. - In a median follow-up of 9.5 years among participants from DANISH, no overall survival benefit was obtained with ICD (implantable cardioverter-defibrillator) implantation in patients with non-ischemic systolic heart failure. In patients ≤70 years, a lower incidence of all-cause mortality, cardiovascular death, and sudden cardiovascular death was observed in relation to ICD implantation.

• In DANISH [Danish Study to Assess the Efficacy of ICDs in Patients with Non-ischemic Systolic Heart Failure on Mortality], there was no overall survival benefit of primary-prevention ICD implantation in patients with non-ischemic systolic heart failure over a median follow-up of 5.6 years, although a beneficial impact on all-cause death was seen in patients ≤70 years.

• This report describes an additional four years of follow-up data from DANISH.

• ICD group did not have significantly lower all-cause death (HR 0.89) vs the control group.

• Lower all-cause mortality in the ICD group vs the control group (30% vs 36%; HR 0.78) was found in patients ≤70 years (n=829), whereas no significant difference in all-cause death was found between the ICD and control group in patients >70 years (n=287) (54% vs 57%; HR 0.92).

• Similar trends were noted in cardiovascular death (overall, 26% vs 29%, HR 0.87; ≤70 years, 22% vs 28%, HR 0.75; >70 years, 36% vs 35%, HR 0.97).

• In the ICD group, a significantly lower incidence of sudden cardiovascular death was observed in the overall population (6% vs 10%; HR 0.60) and in patients ≤70 years (5% vs 11%; HR 0.42), but not in patients >70 years (10% vs 7%; HR 1.34).