Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice. Generally, in patients with low ejection fraction, cause of death in many patients is ventricular arrhythmias, so putting ICD will revert this with the help of shock and restoring normal rhythm. Also, if heart failure is refractory in the form of persistent symptoms like shortness of breath, etc., then these patients may be helped with CRT which synchronizes the chambers of the heart. Both these devices may be combined in a single device called as CRTD. So let me know his echo report and medicines which he is having at present. He should be on antiplatelets like Aspirin, statin like Atorvastatin or Rosuvastatin, beta blockers like Metoprolol and ace inhibitors like Ramipril along with Spironolactone. Hope this helps you and get back if you have any doubts.