Shared decision-making decreases rates of LVAD

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Researchers at the University of Colorado Anschutz Medical Campus found shared decision-making between patients and providers could improve the quality of final decisions in high-risk situations. Findings were published in JAMA Internal Medicine.

Making decisions involving high-risk therapies like the left ventricular assist device (LVAD) can make patients feeling unsure. In this study, researchers examined the impact shared decision-making could have on patient knowledge and overall outcomes.

"LVAD is growing rapidly among people dying from end-stage heart failure who are unable to get a heart transplant," said Larry Allen, MD, an associate professor of medicine-cardiology at the University of Colorado School of Medicine. "These patients decide to live out the remainder of their lives dependent on a partial artificial heart—so-called destination therapy (DT). Although patients may live longer with a DT LVAD, it also poses many risks, including stroke, serious infection and bleeding, and comes with big lifestyle changes."

A total of 248 patients from six American hospitals were included in the study, with 95 percent placed in the intervention group. Patients in this group provided formal decision aids while patients in the control group received local documents and pamphlets from LVAD companies.

Results showed patients in the intervention group had an improved understanding of the LVAD by showing a 5.5 percent increase in correct answers in a knowledge test. The aids also improved values-choice concordance with patients who were more willing to undergo risky surgery for a chance to extend life because they were more likely to receive an LVAD. Patients who didn't want to be dependent on a machine were more likely to refuse LVAD. Overall, patients in the intervention group were less likely to get an LVAD when equipped with more knowledge.