The committee noted the evidence was based on a single trial ) and that the characteristics of the patients in that trial were not representative of the HFREF population in the UK community. In particular, the committee noted the relatively young average age (60 in the CABG arm and 59 in the medical therapy arm). In contrast, the majority of ischemic HFREF patients in the UK are over 70 years of age, and older Chronic Heart Failure Treating Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Recommendations Do not routinely offer coronary revascularisation to people who have heart failure with reduced ejection fraction and coronary artery disease. [2018] patients tend to be frailer and would likely do less well following major surgery such as CABG. 149 After agreeing that CABG should not be routinely offered to typical HFREF patients, the committee discussed whether CABG would be appropriate for patients who present with risk profiles similar to the cohort assessed in STICH(ES). However, the committee was not convinced that the prognostic benefit demonstrated in STICH(ES) would be seen in modern practice. This was primarily because of the relatively small proportion of patients in the trial with Implantable Cardioverter Defibrillators (ICDs), which are now recommended for patients with heart failure and EF 35%.c The committee suggested that a higher rate of ICD usage may have improved the outcomes in the medical therapy arm. For the reasons above, the committee was not convinced that CABG would demonstrate the same beneficial effect in the current UK ischaemic HFREF population, and any possible benefit could be outweighed by an increased risk of serious adverse events during or post-surgery. 