An Intervention to Improve Implantable Cardioverter-Defibrillator Deactivation Conversations (WISDOM)
Communication, Heart Failure
About this trial
This is an interventional supportive care trial for Communication focused on measuring Heart failure, Palliative care, Communication
Eligibility Criteria
Inclusion Criteria:
Clinicians:
- At all sites, a core group of approximately 10 heart failure clinicians (physicians, nurses) care exclusively for patients with advanced heart failure in both inpatient and outpatient settings; all of these clinicians are eligible..
Patients:
- Patient does not currently have a ventricular assist device
- Age > 18
- Fluent in English
- Consistent and reliable access to a phone
For Inpatient:
- Has had at least 1 other heart failure in the last year, OR
Meets all three of the following criteria at time of admission:
- BUN > 43
- SBP ≤ 115
- CR > 2.75 OR
- Was on inotropes OR intravenous diuretics OR intravenous heart failure treatments in emergency department OR in outpatient setting prior to the current hospital admission
For Outpatient
- Has had 2 or more heart failure related admissions in the last year OR
- Has class IV heart failure in the outpatient setting OR
- Has Class III heart failure in outpatient setting AND 1 heart failure related admission in the last year OR
Has Class III heart failure in outpatient setting AND 2 of the following 4 conditions:
- Age ≥ 70
- BUN ≥ 43
- Cr ≥ 2.75
- SBP≤115 OR
- Is on inotropes (e.g., dobutamine, milrinone) OR intravenous diuretics OR intravenous heart failure treatments in emergency department OR in outpatient setting
Caregivers:
- Age > 18
- Fluent in English
- Consistent and reliable access to a phone
Exclusion Criteria for patients:
- Not having an ICD
Sites / Locations
- University of Colorado - Denver
- Yale New-Haven Hospital
- Mayo Medical Center
- Montefiore Medical Center
- Icahn School of Medicine at Mount Sinai
- Hospital of the University of Pennsylvania
Arms of the Study
Arm 1
Arm 2
Experimental
Placebo Comparator
Communication training for cardiologists
Control arm
The intervention consists of an educational workshop for heart failure physicians, a reminder system, and a system providing aggregated feedback on their conversations with patients about ICD deactivation.
Cardiology grand rounds will be held at usual care sites on the importance of advance care planning.