1. The Current Indications for ICD in HF Patients Should be Driven by HF Guidelines Mariell Jessup MD Professor of Medicine University of Pennsylvania Philadelphia, Pennsylvania

4. The data base is the same!!

9. Secondary Prevention

13. CABG (Chronic CAD, mild angina, 3 VD) Hypertension therapy (Diastolic 95-104 mmHg) Cardiac Transplant (CHF, transplant candidate) PTCA (Chronic CAD, mild angina, 1 VD) Primary coronary stenting (CAD, Angina, 1 VD, Male, age 55) Incremental Cost-Effectiveness of Cardiovascular Interventions Expensive Borderline Cost-effective Cost-Effective Highly Cost-Effective Incremental Cost per Life-Year Saved Economically Unattractive Lovastatin (chol. = 290 mg/dL, 50 yrs old, male, no risk factors) *Moss AJ. Presentation at Satellite Symposium, “Cost-Effectiveness of Device Therapy in the Heart Failure Population”, Heart Failure Society of America Annual Meeting September 23, 2003. ICD MADIT II ICD MADIT ICD AVID Total Cost A – Total Cost B Life Expectancy A – Life Expectancy B

16. ESC

18. The Current Indications for ICD in HF Patients Should be Driven by HF Guidelines Despite heterogeneity of entry criteria, the HF guidelines across societies and continents are fairly harmonious. HF physicians respond to system modifications to increase identification of potential patients. The syndrome of heart failure is a relentless enemy, and death is not always delayed by an ICD