Abstract 16934: Information Delivery Affects Patients’ Attitudes Toward Devices More Than Toward Medicines to Treat Heart Failure
Background: Clinical trials have shown the efficacy of oral medications (OM), implantable cardioverter defibrillators (ICD) and left ventricular assist devices (LVAD) for heart failure (HF). To maximize benefit and patient satisfaction, it is valuable for clinicians to understand how the communication of information about these therapies might affect patient preferences.
Methods: We identified 153 ambulatory patients ≥ 65 years old with non-HF cardiovascular condition(s) from a community hospital and a tertiary care center in Massachusetts. Eligible patients completed a structured, phone-based survey interview describing HF and asking their hypothetical preferences for various HF therapies (OM, ICD, LVAD) after receiving information about them. Patients gave their preferences using a 4-pt. Likert scale as they learned incrementally about each therapy’s benefits, detailed regimens or procedures, and complications. Patients did not see the survey in whole at any point or skip questions. We conducted descriptive and Cochran Armitage trend analyses.
Results: Patients were 52% female, 90% white, and had a mean age of 76 years (non-response rate = 2%). Patients responded ‘likely’ less often for device therapies than drug treatment as they learned gradually about therapy benefits, procedures, regimen, and side effects (Figure). Between the initial question and the final question asked for each therapy, the percentage ‘likely’ decreased: from 92% to 87% (ICD) and from 89% to 60% (LVAD) vs. from 98% to 96% (OM) (all p for trend < 0.05). Older patients and women were less likely to prefer device therapies.
Conclusion: As patients learned more about the benefits and risks, they grew less willing to want therapies, with greater decline in preference for device therapies. Our findings support the role of what and how therapy information is presented in order to support shared decision-making and derive the most benefits from HF treatment, including patient satisfaction.
- © 2013 by American Heart Association, Inc.