DECIDE-LVAD: LVAD Shared Decision-Making Intervention Improves Decision Quality

In patients with severe heart failure (HF), use of a shared decision-making intervention for destination therapy (DT) left ventricular assist device (LVAD) may improve decision quality and reduce LVAD implantation, according to results of the DECIDE-LVAD trial presented Nov. 14 at AHA 2017 in Anaheim, CA.

Larry A. Allen, MD, MHS, FACC, et al., looked at 248 patients at six sites who were randomly assigned to a control group of usual care or an intervention group – comprised of clinician education, use of DT LVAD pamphlet and patient video decision aids.

Results showed that the adjusted rate of LVAD implantation at six months was higher for the control group (79.9 percent) than for the intervention group (53.9 percent, p=0.008). Further, the investigators explain that there were no differences in decision conflict, decision regret, or preferred control.

In addition, patient knowledge – measured by mean test performance – improved from 59.5 percent to 64.9 percent in the control group vs. 59.1 percent to 70.0 percent in the intervention group: adjusted difference of difference, 5.5 percent, p=0.030.

The authors conclude that "a shared decision-making intervention for DT LVAD improved patient decision quality as measured by patient knowledge and concordance between stated values and patient-reported treatment preference."

Clinical Topics: Cardiac Surgery, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Cardiac Surgery and Heart Failure, Acute Heart Failure, Mechanical Circulatory Support

Keywords: AHA17, AHA Annual Scientific Sessions, Heart-Assist Devices, Decision Making, Heart Failure, Geriatrics

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