Are We Implanting Too Many Primary-Prevention Implantable Cardioverter-Defibrillators?
Bibliographic record
Abstract
Canadian Cardiovascular Society/Canadian Heart Failure Society guidelines recommend optimizing patients with heart failure with reduced ejection fraction (HFrEF) on guideline directed medical therapy (GDMT) prior to implanting primary prevention implantable cardioverter defibrillators (ICDs). However, often GDMT is suboptimal at the time of ICD implantation, and is associated with reduced survival. Furthermore, with evidence for declining sudden cardiac death (SCD) rates in patients with cardiomyopathy, there is a need for better risk stratification to determine the indication for ICD. 1 This raises concern for potentially unnecessary ICD implantation in this population, and efforts are needed to address this issue in clinical practice.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.087 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.004 | 0.004 |
| Scholarly communication | 0.007 | 0.010 |
| Open science | 0.004 | 0.002 |
| Research integrity | 0.007 | 0.014 |
| Insufficient payload (model declined to judge) | 0.028 | 0.006 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".