Fudim M, Ali-Ahmed F, Parzynski CS, et al. - Researchers conducted this post hoc analysis, utilizing the National Cardiovascular Data Registry ICD Registry, with 81,492 Medicare fee-for-service beneficiaries to analyze utilization rates, patient features, as well as results of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRT-D) placements in patients suffering from advanced heart failure (HF). Patients with NYHA class II and no HF hospitalization within the previous 12 months, no left ventricular assist device, no orthotopic heart transplant listing, and no current or recent inotrope use constituted the comparator group. For primary prevention of sudden cardiac death, all eligible patients had first-time ICD or CRT-D placement. At 30 days, the all-cause mortality rate in the advanced HF group vs in the comparator group was estimated to be 3.1% vs 0.5%, respectively. Overall, advanced HF was detected in only a small proportion of patients receiving ICD or CRT-D placement for primary prevention of sudden cardiac death. Clinically essential periprocedural complication rates related to in-hospital death and cardiac arrest were observed in these patients vs those with nonadvanced HF. A higher risk of death was seen in patients with NYHA class IV, ischemic heart disease, or diabetes.