Response by Golwala et al to Letter Regarding Article, 'Implantable Cardioverter-Defibrillator for Nonischemic Cardiomyopathy: An Updated Meta-Analysis'

We thank Nery et al for their insightful letter to our article.1 We alluded to the age and survival interaction with implantable cardioverter-defibrillator (ICD) use in patients with nonischemic cardiomyopathy (NICM) noted in the DANISH trial (Defibrillator Implantation in Patients With Nonischemic Systolic Heart Failure) in our article.1 We agree that similar trends have been observed in other trials.2 However, only 4 of 6 trials included in our meta-analysis (DEFINITE [Defibrillator in Nonischemic Cardiomyopathy Treatment Evaluation], COMPANION [Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure], SCD-HeFT [Sudden Cardiac Death in Heart Failure Trial], and DANISH)1 reported age-stratified outcomes. Two of the 4 trials, SCD-HeFT3 and COMPANION,4 reported outcomes for both ischemic and nonischemic patients, making age-stratified analysis in patients with NICM difficult in the absence of individual patient–level data. Nonetheless, we do agree that this should be recognized as one of the key limitations of the currently available data we have from the randomized controlled trials. In addition, all treatment decisions for ICD placement should be personalized and involve …