High-quality evidence supports the use of several medications for heart failure (HF)
with reduced ejection fraction, yet their use remains low. Shared decision-making
(SDM) tools, such as decision aids, can bridge evidence-to-practice gaps and improve
the integration of patient preferences to facilitate patient-centred care. At present,
however, little is known about the preferences and decisional needs of patients regarding
these medications. The aim of this study was to characterize the education needs and
treatment preferences of people with HF to facilitate shared decision-making.
METHODS AND RESULTS
We surveyed 52 Canadians living with HF from February-March 2021 who were members
of the HeartLife Foundation support group. The survey instrument included questions
on (1) demographics and HF characteristics, (2) decisional needs assessment, and (3)
patient treatment preferences. Decisional conflict was measured using the low-literacy
10-item Decisional Conflict Scale (DCS). DCS scores range from 0-100, with scores
< 25 and >37.5 associated with implementing and delaying decisions, respectively.
Respondents had a median age 63 years and ejection fraction 40%, 74% were women, and
83% were white. Most participants (58%) reported playing a passive role in previous
HF medication decisions, whereas 27% and 15% reported an active or collaborative role,
respectively. Median total DCS score was 60, with 25% of scores indicative of decisional
implementation and 63% indicative of decisional delay. DCS sub-scores indicated greatest
decisional conflict in the “informed” sub-score (67) and least decisional conflict
in the “support” sub-score (33). Most treatment attributes were ranked as highly important
considerations in decision-making, with mean scores >8/10 for all attributes except
cost (7.5/10), increased lab test frequency (5.8/10), and additional pill burden (4.5-6/10).
Most respondents wished to received information on their HF medications from their
HF specialists (98%), general practitioners (69%) and pharmacist (54%).
In this study of people living with HF, most respondents reported playing a passive
role in decisions regarding their HF medications. Most patients felt at least a moderate
amount of decisional conflict regarding their HF medications, mostly from feeling
uninformed about available options and their related benefits and risks. Decision
aids that address these information gaps may facilitate SDM and improve decision quality.