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Randomized Controlled Trial
. 2022 Aug;28(8):1318-1325.
doi: 10.1016/j.cardfail.2022.04.009. Epub 2022 May 13.

Health Literacy in Patients Considering a Left Ventricular Assist Device: Findings From the DECIDE-LVAD Trial

David S Raymer  1 , Larry A Allen  2 , Erin L Chaussee  3 , Colleen K McIlvennan  2 , Jocelyn S Thompson  2 , Diane L Fairclough  3 , Shannon M Dunlay  4 , Daniel D Matlock  2 , Shane J Larue  5
Affiliations
Randomized Controlled Trial

Health Literacy in Patients Considering a Left Ventricular Assist Device: Findings From the DECIDE-LVAD Trial

David S Raymer et al. J Card Fail. 2022 Aug.

Abstract

Objective: To assess the interaction of health literacy and a shared intervention concerning decision quality in patients considering the destination therapy of left ventricular assist device (DT LVAD) implantation.

Background: Evidence is limited for the use of decision aids by patients with low health literacy and with life-threatening illnesses.

Methods: We performed a secondary analysis of the DECIDE-LVAD Trial, a randomized, stepped-wedge trial conducted from 2015-2017 in the United States. The intervention was the integration of a formal shared decision-making intervention. The main outcome was decision quality as measured by LVAD knowledge and values-treatment concordance. Two components of health literacy were measured by the Rapid Estimate of Adult Literacy in Medicine and Subjective Numeracy Scale instruments.

Results: Of the 228 patients studied, 44% (n = 101) received the formal shared decision-making intervention, and half had low health literacy. Knowledge of LVAD improved for patients with low literacy in the intervention group compared to the control group: the difference in increased knowledge score was 10.6%; P = 0.04. Values-treatment concordance improved significantly for patients with low literacy in the intervention group compared to the control group: the median improvement in values-treatment correlation coefficient was 0.43; P = 0.03. These benefits were not significant in those with adequate literacy (n = 171). Patients with low numeracy (n = 94) did not show significant improvements in either measure of decision quality, and patients with adequate numeracy (n = 134) showed improvement in LVAD knowledge but not in values-treatment concordance.

Conclusions: Patients considering DT LVAD implantation with low literacy showed improvement in decision quality after the integration of a shared decision-making intervention.

Trial registration: ClinicalTrials.gov NCT02344576.

Keywords: Health literacy; heart failure; left ventricular assist device; patient decision aid.

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