Video decision support tool improves knowledge in Black implantable cardioverter-defibrillator candidates

by Grace Yin, Kiera Liblik

Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. In this randomized controlled trial, a video decision support tool (VIVID) increased knowledge about sudden cardiac death and implantable cardioverter-defibrillators (ICDs) amongst Black ICD candidates.

2. VIVID did not result in increased assent rates to ICD implantation compared to usual care in Black patients.

Evidence Rating Level: 3 (Average)

Study Rundown:

Sudden cardiac death is a leading cause of morbidity within the United States, and patients with heart failure are at increased risk. Clinical practice guidelines have recommended the implantation of an ICD as a primary prevention method against sudden cardiac death for at-risk populations. Historically, racial disparities in the uptake of ICD implantation for high-risk patients have been studied, with Black-identifying patients having lower rates of ICD implantation uptake. Although the reasons for this are complex and multifactorial, this study aimed to investigate whether VIVID increases the uptake of ICD implantation amongst Black patients. The primary outcome of interest was the rate of assent for ICD implantation. Results of the study found that there was no difference in rates of assent for ICD implantation between the VIVID group and the usual care group. However, participants in the video intervention group demonstrated a higher mean knowledge score when compared to participants in the usual care group. Overall, this study assessed the effectiveness of a tool designed to reduce observed racial disparities in assent for ICD implantation. A notable limitation of this study is its generalizability. As the study recruited from outpatient cardiac electrophysiology clinics, results cannot be generalized to participants who do not have access to this form of specialized care, including those who do not have access for social determinants of health reasons. Further, the contributing factors to racial disparities in healthcare are complex, requiring systemic changes.

In-Depth [randomized controlled trial]:

This study was a randomized, parallel-design trial evaluating the effectiveness of an educational video tool (VIVID) at increasing knowledge, reducing decisional conflict, and increasing the uptake of ICDs amongst Black patients with indications. The primary endpoint was the rate at which patients decided to assent to ICD implantation compared with usual care. Adult participants were invited to participate if they were in the ambulatory setting, had heart failure with an ejection fraction of ≤35% with New York Heart Association class I to III symptoms, and self-identified as Black. In total, 343 patients were randomly assigned in a 1:1:1 ratio to a video decision support tool which featured clinicians and patients who were Back (concordant group), a video decision support tool which featured clinicians and patients who were White (discordant group), or usual care. Results of the primary analysis found that there was no significant difference in assent to ICD implantation between the video intervention group and the usual care group (difference, -0.8%; 95% Confidence Interval [CI], -13.2%-11.1%), and there was no difference in the primary outcome when stratified by racial concordance within the videos. However, participants in the video intervention group demonstrated a higher average knowledge score on ICD implantation compared to those receiving usual care (difference, 0.7; CI 0.2-1.1). In summary, this study demonstrated that the educational video support tool was ineffective at significantly changing the rate of assent for ICD implantation amongst Black patients. However, it was effective at increasing participant knowledge and may be a beneficial tool to integrate into the appropriate context for this purpose.

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