Sudden death prevention in heart failure

Heart failure is one of the main clinical entities in modern society, with a prevalence of 0.4 to 2% in Europe. It has an adverse prognosis, with 5 to 20% annual mortality, even when properly medicated. Mortality in heart failure is frequently due to sudden death, which means preventive strategies should be adopted. Risk stratification is essential in order to identify which patients will benefit most. The main risk factor for sudden death is low ejection fraction. However, ECG data, Holter monitoring and electrophysiological studies are also useful. In primary prevention, all reversible conditions and precipitating factors should be identified and heart failure treatment optimized. The best preventive strategy, after appropriate patient selection, is ICD implantation. Recently, devices with both cardioversion-defibrillation and cardiac resynchronization have proved beneficial in terms of morbidity, quality of life and survival.