Recommendation-Specific Supportive Text 1. The rationale for recommending that an ICD be offered to patients with NYHA class II or III HF, in addition to LVEF 35%, is based on the sur- vival benefit observed in SCD-HeFT and MADIT-II (which used LVEF cutoff of below 35% and 30%, respectively). Selection for implantation of an ICD must be individualized. Patients with serious comorbidities associated with a survival of <1 year are generally not considered ICD candidates. The recommendation to wait at least 40 days after an MI before implanting a primary prevention ICD is based on the fact that such patients were excluded from MADIT-II and SCD-HeFT and 2 other RCTs showed no survival benefit from ICDs implanted early after an acute MI.S7.1.2-10,S7.1.2-11 2. In the MADIT-II trial,S7.1.2-2 which randomized patients with LVEF 30% and prior MI to an ICD or not, approximately one third of the patients had NYHA class I symptoms. A subgroup analysis supported benefit of the ICD on survival in this 3. Economic outcomes of ICD implantation for primary prevention of SCD were assessed in 3 and SCD- which all had generally consistent results. All studies reported increased survival and life expectancy, and higher lifetime costs of medical care with an ICD than without an ICD. The incremental cost-effective- ness ratios were generally <$50000 per year of life added by an ICD, which provides high value according to the benchmarks adopted for the The value provided by an ICD was consistently high when life expectancy was projected to increase by >1.4 years.S7.1.2-18 In Figure 4. Primary prevention of SCD in patients with ischemic heart disease. Colors correspond to Class of Recommendation in Table 1. See Section 7.1.2 for discussion. 