Sudden cardiac arrest (SCA) is the leading cause of death in the United States, accounting for approximately 450 000 deaths annually. Data from randomized clinical trials and systematic reviews have demonstrated the efficacy of implantable cardioverter-defibrillator (ICD) therapy to improve survival in patients with chronic systolic heart failure. However, despite guideline recommendations for ICD implantation for the primary prevention of SCA in at-risk populations, Black patients have lower rates of ICD implantation than do White patients. Reasons for racial disparities in ICD implantation remain enigmatic, but they are explained in part by higher refusal rates. A decision support tool may be an effective intervention to address barriers to ICD implantation in at-risk Black patients.
