MADIT-ICD Benefit Score

Refined ICD Primary Prevention Benefit Estimation

Identifies patients most likely to derive survival benefit from prophylactic ICD therapy beyond standard LVEF ≤ 35% criteria. Derived from MADIT-II data — helps refine the decision in borderline candidates and competing-risk scenarios.

Age (years)

LVEF (%) ≤ 35%

QRS Duration (ms)

BUN (mg/dL)

NYHA Class

I II III

Atrial fibrillation

Non-sustained VT on Holter

Clinical Context

MADIT-II: Enrolled ischemic CMP with LVEF ≤30%. 31% relative risk reduction in all-cause mortality with ICD.
Highest benefit: Younger age, wider QRS, preserved renal function, NSVT on monitoring.
Reduced benefit: Advanced age, severe renal dysfunction (competing non-cardiac mortality), narrow QRS without NSVT.
Non-ischemic: DANISH trial showed ICD benefit primarily in patients <68 years. Consider age-stratified approach.

Reference

Goldenberg I et al. (2008) — Risk stratification for primary implantation of a cardioverter-defibrillator. JACC. 51(3):288–296.

MADIT-ICD Benefit Score

ICD Benefit Assessment

Clinical Context

Reference