Effectiveness of Implantable Cardioverter Defibrillator (ICD) vs. Medical Therapy in Reducing Mortality in Patients with Heart Failure: Systematic Review and Meta-Analysis

Abstract

Heart failure is one of the most frequent and severe diseases today, which is characterized by a high mortality rate and a high rate of sudden cardiac death, primarily because of ventricular arrhythmias. ICD is one of the most useful and widely used device to manage high-risk HF patients and mainly to prevent SCD. The present systematic review and meta-analysis are also designed to compare the impact of ICDs with that of standard medical therapy on all-cause mortality of patients with HF. A systematic PubMed/MEDLINE and Cochrane library search was done from 2000 to July 2024 to attain RCTs and other observational studies. The pooled analysis demonstrated a significant 15% reduction in all-cause mortality with ICD therapy (Risk Ratio [RR] 0.85, 95% Confidence Interval [CI] 0.75-0.95, p = 0.005). Subgroup analyses indicated that patients with ischemic heart failure benefited more from ICDs than those with non-ischemic etiology. Despite substantial heterogeneity among studies (I² = 65%), sensitivity analyses confirmed the robustness of these findings. However, issues such as potential publication bias and heterogeneity of effects across subgroups of patients point to the need for individual tailoring of ICD implantation. More speculation is needed for designing definitive conclusions and tracking more extended benefits and impaired effects, specifically among minority communities.