Heart failure & cardiomyopathiesMeta-analysis
Time to rethink ICD indications in non-ishaemic cardiomyopathy? Evidence from a meta-analysis across therapeutic eras
- meta-analysis
- randomized controlled trials
Authors' conclusion
All contemporary ‘GDMT-era’ absolute benefit estimates are scenario-based modelling outputs. No randomized trial has evaluated ICDs on top of full modern GDMT in NICM; therefore, these results represent illustrative ranges rather than empirical estimates.
Study context
- Population
- Non-ischaemic cardiomyopathy (NICM) with left ventricular ejection fraction ≤35%Three trials (DEFINITE, SCD-HeFT NICM subgroup, and DANISH)
- Comparison
- prophylactic ICD implantation vs control in NICM
Pooled result
All-cause mortality
Pooled hazard ratio
0.79
95% CI 0.66–0.95
ICD vs control
pooled HR 0.79 (95% CI 0.66–0.95)
As reported in the abstract
Further pooled results
| Outcome | Values | HR (95% CI) | |
|---|---|---|---|
| SCD | 0.44 (0.28–0.70) | ||
| 0.20.5125Hazard ratio (log scale) |
| Outcome | Values | Estimate |
|---|---|---|
| Absolute risk reduction · Five-year | SCD-HeFT NICM ARR 5.9% · NNT 17 · DANISH ARR 4.4% · NNT 23 |
Projected absolute benefit under a full-GDMT scenario (modelling)
- projected baseline risk
- ∼11%
- Absolute risk reduction (ARR)
- 2.31%
- NNT
- 43
- parameterized from pharmacological randomized controlled trials
- scenario-based modelling outputs
Original publication
Time to rethink ICD indications in non-ishaemic cardiomyopathy? Evidence from a meta-analysis across therapeutic eras. ESC Heart Fail. Published 10 February 2026. doi:10.1093/eschf/xvag047
Summarised from the published abstract; every number is checked against it