Many patients with advanced HF listed for heart transplant would not otherwise qualify for ICD given the severity of illness including NYHA class IV status and/or use of inotropic infusion. Although no randomized data on ICD use in this popula- tion exist, data from observational and large registry studies of patients awaiting heart trans- plant suggest improved survival in patients with One alternative to ICD in this population is the wearable cardioverter- The recommendation in this section is relevant to those patients without an ICD where there is a plan to discharge the patient to home to await cardiac transplant and not, for example, to those patients who remain hospitalized with no intention to discharge home until transplant occurs. For those patients with an LVAD, the decision to place an ICD is gener- ally independent of whether they are awaiting heart transplant but rather the indication in those patients is generally based on the need to treat 7.7.2. HF With Preserved Ejection Fraction Nearly half of the patients with HF have a preserved These patients tend to be older and have more comorbidities than patients with HFrEF. Howev- er, although the rate of SCD is lower in patients with HF with preserved ejection fraction (HFpEF) than in patients with HFrEF,S7.7.2-2 nearly a quarter of all deaths among patients with HFpEF are sudden.S7.7.2-3 S7.7.2-5 The challenge in preventing SCD in patients with HF- pEF is identifying which patients are at a high enough risk to benefit from preventive therapies. Studies ex- ploring noninvasive risk factors for SCD in patients with HFpEF do not identify consistent factors with the exception of ischemic heart disease.S7.7.2-2,S7.7.2-6 Consequently, there is no accepted noninvasive test to identify high-risk patients with HFpEF. 