Abstract 13922: Reducing Health Care Disparities by Improving ICD Knowledge in a Diverse Population, a Quality Improvement Initiative to Align ICD Settings With Goals of Care

Abstract

Background: Patients with implantable cardioverter defibrillators (ICDs) often lack understanding of ICD functioning, most dramatically in at-risk populations. Patient knowledge gaps preclude adequate communication regarding goals of care and informed decision-making with the potential for unwanted shocks at end of life (EOL). Both ICD studies and ICD patient education tools historically lack both diversity and accessibility. Ways to improve patient ICD comprehension in populations with barriers to care have not been well established. Research Questions: Does a patient-centered educational video improve ICD knowledge and/or affect patients’ ICD preferences in hypothetical EOL scenarios? Methods: We surveyed 30 admitted heart failure patients with ICDs using 10 validated true-false ICD knowledge questions, 4 preference questions in hypothetical EOL scenarios, and multiple qualitative questions at a diverse urban, safety-net hospital. A novel 7-minute ICD educational video narrated by real patients with ICDs, using 3 rd grade or below language was then shown either in English or Spanish. Post viewing, the same questions were repeated to assess knowledge and preferences. (Link to video: https://youtu.be/8n_M--33Ia w ) Results: The mean age was 58 years, and 38% identified as female. Of the 30 patients, 63% were Black, 37% were White, and 17% were Hispanic. Patients had a mean ejection fraction of 31%, and 50% of participants had prior ICD shocks (1 to 14 times). The mean pre-test knowledge score was 50% (SD 22.8) and mean post-test score significantly improved to 82% (SD 15.1) correct (W=346, p<0.00001). Scores did not significantly vary by age, sex, race, or prior shock status. After watching the video, 66% of patients changed their EOL ICD preferences in at least 1 scenario. All participants rated the video as either very helpful or helpful. Conclusion: In a diverse group of admitted heart failure patients with ICDs, intervention with an educational video on ICDs and shocks at EOL significantly improved patient knowledge. Educational materials designed for diverse patient populations can reduce healthcare disparities, by expanding patient knowledge and therefore empowering patients to make informed decisions on ICDs at EOL.