Elsevier

American Heart Journal

Volume 166, Issue 1, July 2013, Pages 157-163.e2
American Heart Journal

Clinical Investigation
Electrophysiology
Educational Videos to Reduce Racial Disparities in ICD therapy Via Innovative Designs (VIVID): A randomized clinical trial

https://doi.org/10.1016/j.ahj.2013.03.031Get rights and content

Background

Black individuals eligible for an implantable cardioverter/defibrillator (ICD) are considerably less likely than white individuals to receive one. This disparity may, in part, be explained by racial differences in patient preferences. We hypothesized that a targeted patient-centered educational video could improve knowledge of sudden cardiac arrest (SCA) and ICDs and reduce racial differences in ICD preferences. We conducted a pilot study to assess the feasibility of testing this hypothesis in a randomized trial.

Methods

We created a video that included animation, physician commentary, and patient testimonials on SCA and ICDs. The primary outcome was the decision to have an ICD implanted as a function of race and intervention. Between January 1, 2011, and December 31, 2011, 59 patients (37 white and 22 black) were randomized to the video or health care provider counseling/usual care.

Results

Relative to white patients, black patients were younger (median age, 55 vs 68 years) and more likely to have attended college or technical school. Baseline SCA and ICD knowledge was similar and improved significantly in both racial groups after the intervention. Black patients viewing the video were as likely as white patients to want an ICD (60.0% vs 79.2%, P = .20); and among those in the usual care arm, black patients were less likely than white patients to want an ICD (42.9% vs 84.6% P = .05).

Conclusion

Among individuals eligible for an ICD, a video decision aid increased patient knowledge and reduced racial differences in patient preference for an ICD.

Section snippets

Video production

A multidisciplinary team of physicians, nurses, and research assistants developed the initial core content for the educational videos using a variety of resources including current national guidelines, relevant epidemiological statistics, Krames multimedia material, and other published data.22, 23 Following content development, a script and a video layout were created with assistance from staff at Duke Media Services. Each of the videos contained the same content. However, in one video, the

Results

Between January 1, 2011, and December 31, 2011, 59 patients eligible for a primary prevention ICD (37 white and 22 black) were enrolled. Of the 60 eligible patients approached for the study, 59 (98%) agreed to participate. We obtained complete data on 56 of the 59 study participants. Two white patients and 1 black patient in the UC arm were missing 1-week data from the decisional conflict scale and 1-week knowledge questionnaire. Baseline characteristics were balanced between video and UC

Discussion

In this randomized pilot study, we examined the effect of a patient-centered educational video on the decision to have an ICD placed for the primary prevention of SCA in black and white patients. Our study had 4 main findings. First, both patient-centered educational video and health care provider counseling without a video (UC) increased patient knowledge of SCA and ICD therapy in black and white patients. Second, a video-based decision aid decreased the racial disparity in the preference for

Conclusions

A patient-centered video increased black participants’ knowledge of SCA and ICDs and provided similar acceptance of ICD implantation relative to white patients. Decisional conflict was similar between black and white patients. Despite our intervention, black patients were less likely to have an ICD implanted within 90 days. Our findings should be further assessed by a large, prospective, multicenter, randomized clinical trial.

Disclosures

No disclosures to report.

Acknowledgements

We thank participants in the video, members of our focus groups, and the health care workers who reviewed the videos. We also thank Greg Hobbs for filming and editing the videotapes, Patty McAdams for drafting the physician and narrator script and for interviewing the participants for the video, and Vincent Miller for recruiting focus group members and facilitating the focus groups. Thanks also to Bob Sanderford for data entry and cleaning and to Sean O’Brien, PhD, for developing the

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    RCT# NCT00918125.

    www.clinicaltrials.gov/ct2/show/NCT00918125.

    Gregg C. Fonarow, MD, served as guest editor for this article.

    Funding support: This project was supported in part by a research grant from Medtronic, Inc. Additional funding was provided by cooperative agreement number 1U18HS016964 from the Agency for Healthcare Research and Quality (AHRQ). Neither AHRQ nor Medtronic, Inc, has evaluated the videos, designed the evaluation process, assisted in data collection or analysis, or provided input into this paper. The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ or Medtronic, Inc.

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