CRT‐D Therapy in Heart Failure: How Much Do NYHA Class IV Patients Benefit?

For many of these patients, gains inpharmacologic therapy have helped signicantly in delayingprogression to transplantation requirement. However, evenwith the advent of angiotensin converting enzyme inhibitors,beta blockers, and aldosterone antagonists, overall attritionin the advanced HF population is still substantial.Device therapy, rst with implantable cardioverter de-brillators (ICDs) and, more recently, with cardiac resyn-chronization (CRT) or combination (CRT-D) devices, hasprovideddocumentedsurvivalbenet(oratleastclinicalben-et [the initial CRT trials]) beyond medical therapy alone intheadvancedHFpopulation.