'Personalized care': attitude and implantable cardioverter-defibrillator (ICD) therapy in Denmark

This editorial refers to ‘Attitudes towards implantable cardioverter-defibrillator therapy: a national survey in Danish health-care professionals’ by J.B. Johansen et al ., on page 663. Implantable cardioverter-defibrillator (ICD) therapy for primary prevention is a class I indication in high-risk patients with both ischaemic and non-ischaemic heart disease, supported by evidence from several randomized trials. However, despite the overall positive results of the studies and the recommendation in the guidelines, only a fraction of patients with an indication for ICD therapy will actually receive a device, and there are also substantial differences in implant rates across the European countries. The likely reasons for this discrepancy include: (i) reimbursement issues, (ii) personal attitude of implanting and particularly, referring physicians, (iii) patient preference, (iv) medical traditions in some countries, and (v) other practical limitations of device availability.In addition, difficulties with ICD therapy remain [e.g. multiple shocks, inappropriate therapy, device infections, lead malfunction, quality-of-life (QoL) issues, etc.], and there is more compelling evidence of the …