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In Reply: Dr Stamato raises interesting issues regarding interpretation and implementation of clinical trial results. We agree that it is important to consider the types of patients who were enrolled in clinical trials when considering the generalizability of these trial findings. Clinicians treat individual patients who have complex combinations of characteristics, rather than the groups of patients that are the basis of clinical trial results.¹ Stamato is correct that patients in the major ICD trials tended to be younger and to have fewer comorbid conditions than heart failure patients in community practice.²

We restricted our analyses to only those patients who met criteria for an ICD based on American College of Cardiology/American Heart Association (ACC/AHA) professional guidelines.³ We also excluded patients with contraindications noted by a physician or reasons noted by a patient declining an ICD. Physicians could indicate contraindications based on comorbid conditions, patient preferences, quality of life, or . . . [Full Text of this Article]

Adrian F. Hernandez, MD, MHS
herna014@mc.duke.edu
Duke Clinical Research Institute
Durham, North Carolina

Gregg C. Fonarow, MD
UCLA Medical Center

Eric D. Peterson, MD, MPH
Duke Clinical Research Institute

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Sex and Racial Differences in the Use of Implantable Cardioverter-Defibrillators Among Patients Hospitalized With Heart Failure
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