MADIT-II ICD Mortality Benefit Score (MADIT-ICD Benefit Score)

MADIT-ICD Benefit Score — Explanation and clinical context The MADIT-ICD Benefit Score (Younis et al., 2021) integrates two competing risk scores to predict the likelihood that a patient with low LVEF will derive survival benefit from a prophylactic implantable cardioverter-defibrillator (ICD). The first component estimates the risk of life-threatening ventricular tachyarrhythmia (VT/VF) using eight clinical predictors (male sex; age <75 years; prior non-sustained VT; resting heart rate >75 bpm; systolic blood pressure <140 mmHg; LVEF ≤25%; prior myocardial infarction; and atrial arrhythmia). The second component estimates the competing risk of non-arrhythmic mortality using seven predictors (age ≥75 years; diabetes mellitus; BMI <23 kg/m²; LVEF ≤25%; NYHA class ≥II; presence of CRT (CRT-D reduces the score); and atrial arrhythmia).

In the original derivation each predictor is assigned a point value; the VT/VF score ranges 0–13 and the non-arrhythmic mortality score ranges 1–10. Patients are classified into three benefit groups by combining dichotomized versions of the two scores: Highest benefit = high VT/VF & low non-arrhythmic score; Intermediate = either both low or both high; Lowest benefit = low VT/VF & high non-arrhythmic score. The authors also provide a personalized 0–100 benefit score (higher = greater expected ICD benefit) and an online calculator / conversion table in the manuscript supplement.

Clinically, the highest group shows the largest absolute reduction in mortality from ICD therapy at 3 years, intermediate shows smaller benefit, and lowest shows the least; the score is intended to support individualized shared decision-making rather than to replace clinical judgement.