{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T11:40:11Z","timestamp":1779190811794,"version":"3.51.4"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2020,4,21]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>BACKGROUND<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Medical therapy for heart failure with reduced ejection fraction evolved since trials validated the use of implantable cardioverter\u2013defibrillators (\n              <jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content>\n              s). We sought to evaluate the performance of\n              <jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content>\n              s in reducing mortality in the era of modern medical therapy by means of a systematic review and meta\u2010analysis of contemporary randomized clinical trials of drug therapy for heart failure with reduced ejection fraction.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>METHODS AND RESULTS<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We systematically identified randomized clinical trials that evaluated drug therapy in patients with heart failure with reduced ejection fraction that reported mortality. Studies that enrolled &lt;1000 patients, patients with left ventricular ejection fraction &gt;40%, or patients in the acute phase of heart failure and study treatment with devices were excluded. We identified 8 randomized clinical trials, including 31\u00a0701 patients of whom 3631 (11.5%) had an\n              <jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content>\n              .\n              <jats:styled-content style=\"fixed-case\">ICDs<\/jats:styled-content>\n              were associated with a lower risk of all\u2010cause mortality (relative risk [RR], 0.85; 95% CI, 0.78\u20130.94) and sudden cardiac death (RR, 0.49; 95% CI, 0.40\u20130.61). Results were consistent among studies published before and after 2010. In meta\u2010regression analysis, the proportion of nonischemic etiology did not affect the associated benefit of\n              <jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content>\n              .\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>CONCLUSIONS<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              In our meta\u2010analysis of contemporary randomized trials of drug therapy for heart failure with reduced ejection fraction, the rate of\n              <jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content>\n              use was low and associated with a decreased risk in both all\u2010cause mortality and sudden cardiac death. This benefit was still present in trials with new medical therapy.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.119.015177","type":"journal-article","created":{"date-parts":[[2020,4,15]],"date-time":"2020-04-15T09:06:12Z","timestamp":1586941572000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Implantable Cardioverter\u2013Defibrillators in Trials of Drug Therapy for Heart Failure: A\u00a0Systematic Review and Meta\u2010Analysis"],"prefix":"10.1161","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5840-3721","authenticated-orcid":false,"given":"Francisco","family":"Gama","sequence":"first","affiliation":[{"name":"Hospital Santa Cruz Centro Hospitalar Lisboa Ocidental Nova Medical School Faculdade de Ci\u00eancias M\u00e9dicas Lisbon 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Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salom\u00e9","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Hospital Santa Cruz Centro Hospitalar Lisboa Ocidental Nova Medical School Faculdade de Ci\u00eancias M\u00e9dicas Lisbon Portugal"},{"name":"Hospital da Luz Lisbon Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pedro","family":"Carmo","sequence":"additional","affiliation":[{"name":"Hospital Santa Cruz Centro Hospitalar Lisboa Ocidental Nova Medical School Faculdade de Ci\u00eancias M\u00e9dicas Lisbon Portugal"},{"name":"Hospital da Luz Lisbon Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diogo","family":"Cavaco","sequence":"additional","affiliation":[{"name":"Hospital Santa Cruz Centro Hospitalar Lisboa Ocidental Nova Medical School Faculdade de Ci\u00eancias M\u00e9dicas Lisbon Portugal"},{"name":"Hospital da Luz Lisbon 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