2/2005) were screened in 22 centers for cardiac rehabilitation in Germany (76% male, 62 12 yrs). 75% of pts had the last MI 4 to 8 weeks prior to inclusion, in 90% it was their first MI. 90% of the pts had revascularization before inclusion, mainly PCI (74%) and/or CABG (25%). Additional diseases: hypertension, diabetes, renal insufficiency, atrial fibrillation in 72%, 25%, 5% and 3% of pts respectively. Medication at discharge from rehabilitation consisted of -blockers (95%), ACE-inhibitors (90%), statins and antiplatelet agents in 96% of pts. Mean LVEF: 56 12%. Pts were classified according to their LVEF at inclusion: group 1 with LVEF 30%, group 2 with 30% LVEF 40%, and control group 3 with LVEF 40%. All pts are followed-up during 3 years to document cause of death, cardiac events and interventions. Results: 216 pts (2.6%) out of 8.430 ( 100%) had a LVEF 30%, 557 pts (6.7%) had 30% LVEF 40%. Only 47 pts (22%) of group 1 received an ICD either early during the rehabilitation phase (25 pts,12 %) or later initiated by their local practitioners (12 pts,10%). The reasons for 78% of the pts not receiving ICD implant are diverse (details will be presented). Conclusions: The incidence of pts after MI with severely impaired LVEF 30% (2.6%) is smaller than expected from data of the 1990s. Although the vast majority of these pts were medicated according to guidelines, only 22% received ICD therapy in line with randomized studies despite the small incidence of this pt type.