Implantable defibrillators and β-blockers in patients with left ventricular dysfunction: Economic, ethical, and legal considerations

This article is going to be somewhat different than the typical article you might read on the treatment of heart failure. My goal is to get you to think in a different way about the use of primary prevention implantable cardioverter defibrillators and β-blockers in patients with left ventricular dysfunction. Specifically, using the results from 3 landmark clinical trials—MADIT II, SCD-HeFT, and COMET—I am going to discuss the economic, ethical, and legal principles that underpin the use of these 2 therapies in patients with heart failure.