Clarification of the Australian heart failure guideline recommendation for primary prevention defibrillator implantation in non‐ischaemic cardiomyopathy

The use of defibrillators for ventricular arrhythmias may significantly reduce mortality when sudden cardiac death is the major contributor

The 2018 guidelines from the National Heart Foundation and the Cardiac Society of Australia and New Zealand provide evidence‐based direction for the management of heart failure in Australia.1 A Perspective article published in the Journal in 20192 challenged the weak recommendation for the implantation of a defibrillator in the primary prevention of mortality in dilated cardiomyopathy (DCM) with a left ventricular ejection fraction (LVEF) of 35% or below.1 The authors of the MJA article2 questioned the differences between this recommendation1 and recent Canadian and American guidelines.3,4 We welcome this opportunity to clarify the basis for the Australian guidelines recommendation.