Background/Aims: This study aims to determine the current trends and barriers to the implantation of Implantable Cardioverter-Defibrillators (ICDs) in patients with ST-segment Elevated Myocardial Infarction (STEMI) complicated by Heart Failure with reduced Ejection Fraction (HFrEF) at the regional tertiary centre of Townsville University Hospital (TUH) in North Queensland, Australia. Methods: A retrospective chart review was conducted on patients coded as having a STEMI complicated by new HFrEF, defined as left ventricle ejection fraction (LVEF) of 40% or less, treated at TUH from 1/1/2018 to 31/12/2023. The data points collected included demographics, atherosclerotic risk factors, laboratory results, echocardiographic and angiographic findings, Guideline-Directed Medical Therapy (GDMT), ICD implantations and barriers to ICD implantation. Results: A total of 255 patients were included in the review; however, 64 patients were lost to follow-up. Of the remaining 191, 45 patients met an indication for ICD implantation according to current guidelines; although, only 15 patients underwent ICD implantation. The primary barriers to ICD implantation that were identified are as follows: lack of referral for ICD consideration (40%), poor prognosis/frailty (27%), patient refusal (20%), complete non-adherence to GDMT (10%), and death (3%). Conclusion: A low rate of ICD implantation was observed, with patient and non-patient related barriers identified as potentially actionable areas to improve ICD implantation rate. There was a high rate of patients being lost to follow-up, potentially leading to suboptimal patient outcomes. It is recommended that service improvement and redesign are implemented to ensure the population of North Queensland receives optimal cardiac care.