Canadian Journal of Cardiology



      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.


      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.
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