CE-454029-1 THE IMPACT OF GENDER ON DECISIONAL CONFLICT SURROUNDING IMPLANTABLE CARDIOVERTER DEFIBRILLATOR IMPLANTATION AMONG BLACK PATIENTS AT RISK FOR SUDDEN CARDIAC DEATH

Abstract

Implantable cardiac defibrillators (ICD) reduce the risk of sudden cardiac death (SCD) in patients with heart failure with reduced ejection fraction (HFrEF). Previous studies have shown that women are less likely to undergo ICD implantation than men. "Videos to Address Racial Disparities in Implantable Cardioverter-Defibrillators Via Innovative Designs (VIVID): A Randomized Clinical Trial" (VIVID) investigated the impact of a video-based decision support tool on the decision for ICD implantation and associated decisional conflict. The overall aim of this study is to analyze the impact of gender on decisional conflict and ICD receipt among Black men and women with HFrEF at risk for SCD. The VIVID trial was conducted from September 2016 to April 2020. Gender and race were self-reported. Black patients were randomized to a video-based decision support tool or usual care. A decisional conflict scale (DCS) adapted from the Ottawa Decision Support Framework was used to assess decisional conflict associated with ICD implantation before and after the intervention. Logistic regression was used to measure differences in ICD implantation within 90 days of study enrollment and the association between decisional conflict and ICD implantation between men and women at 90 days. ANCOVA regression was used to measure differences in DCS between Black men and women and the interaction by intervention group. Among 330 Black patients included in the final analysis, 309 patients (197 men and 112 women) had gender and DCS data available. At 90-day follow-up, 73.9% of women compared with 61.9% of men underwent ICD implantation (adjusted OR (95% CI): 2.07 (1.14, 3.78); p=0.02). There was no significant interaction between gender and intervention for ICD implantation. Among all participants, decisional conflict scores decreased and did not differ by intervention (adjusted mean difference (95% CI): -2.00 (-4.05, 0.05)). Women had a greater mean decrease in DCS scores than men (adjusted mean difference (95% CI): -2.16 (-4.23, -0.09); p=0.04); and there was no significant interaction between gender and intervention in DCS scores (p=0.32). Among Black patients eligible for an ICD, women had less decisional conflict associated with ICD implantation and were more likely to receive an ICD than men. Future research should seek to understand the role of gender on decision-making for an ICD.Tabled 1Table 1. Differences in ICD Implantation within 90 Days.Number of ICD Implants/Total (%)Odds Ratio (95% CI)P-valueIntervention GroupUsual Care71/99 (71.7%)Video-Based Decision Support Tool128/203 (63.1%)1.48 (0.83, 2.63)0.18GenderMen118/192 (61.5%)Women81/110 (73.6%)2.07 (1.14, 3.78)0.02All values are adjusted for patient characteristics including age, educational attainment, income, marital status, work status and pertinent comorbidities including hypertension, hyperlipidemia, diabetes, coronary artery disease and atrial fibrillation. Open table in a new tab