Primary Prevention of SCD in Patients With Ischemic Heart Disease Recommendations for Primary Prevention of SCD in Patients With Ischemic Heart Disease References that support the recommendations are summarized in Online Data Supplement 21. COR LOE Recommendations I A In patients with LVEF of 35% or less that is due to ischemic heart disease who are at least 40 days post-MI and at least 90 days postrevascularization, and with NYHA class II or III HF despite GDMT, an ICD is recommended if meaningful survival of greater than 1 year is expected.S7.1.2-1,S7.1.2-2 I A In patients with LVEF of 30% or less that is due to ischemic heart disease who are at least 40 days post-MI and at least 90 days postrevascularization, and with NYHA class I HF despite GDMT, an ICD is recommended if meaningful survival of greater than 1 year is Value Statement: High Value (LOE: B-R) A transvenous ICD provides high value in the primary prevention of SCD particularly when the patient s risk of death due to a VA is deemed high and the risk of nonarrhythmic death (either cardiac or noncardiac) is deemed low based on the patient s burden of comorbidities and I B-R In patients with NSVT due to prior MI, LVEF of 40% or less and inducible sustained VT or VF at electrophysiological study, an ICD is recommended if meaningful survival of greater than 1 year is expected.S7.1.2-5 CLINICAL STATEMENTS AND GUIDELINES IIa B-NR In nonhospitalized patients with NYHA class IV symptoms who are candidates for cardiac transplantation or an LVAD, an ICD is reasonable if meaningful survival of greater than 1 year is expected.S7.1.2-6 S7.1.2-9 III: No Benefit C-EO An ICD is not indicated for NYHA class IV patients with medication-refractory HF who are not also candidates for cardiac transplantation, an LVAD, or a CRT defibrillator that incorporates both pacing and defibrillation capabilities. 