Predictors of primary prevention implantable cardioverter-defibrillator use in heart failure with reduced ejection fraction: impact of the predicted risk of sudden cardiac death and all-cause mortality.

In a contemporary registry, only 15.5% of patients with an indication for primary prevention ICD received the device. While a high predicted proportional SCD risk was appropriately linked to ICD use, the lack of specialized follow-up, higher comorbidity burden, and lower socioeconomic status were major unjustified impediments to implementation. Our findings suggest areas for improving ICD use for primary prevention of SCD in clinical practice.