Arrhythmia, Devices
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9/Pre-implant animation improves implantable loop recorder consent: a single center quality improvement project

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Published Online: Oct 3rd 2011 European Journal of Arrhythmia & Electrophysiology. 2021;7(Suppl. 1):abstr9
Authors: C Monkhouse (Presenting Author) - Barts Heart Centre, London; H Harvie - Barts Heart Centre, London;R Mravljak - Barts Heart Centre, London; J Binoy - Barts Heart Centre, London; K Belleca - Barts Heart Centre, London; H Caldeira - Barts Heart Centre, London; R Ang - Barts Heart Centre, London; A Muthumala - Barts Heart Centre, London; P Moore - Barts Heart Centre, London; M Earley - Barts Heart Centre, London; DS Wald - Barts Heart Centre, London
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Background: Implantable loop recorders (ILRs) are small cardiac rhythm monitoring devices that require a minor invasive procedure to implant. ILR implants are increasing following recommendations for their use in the NICE guidance for secondary stroke prevention. Implants are often performed by nurse and cardiac scientist specialists with variable levels of patient information provided before consent. A multi-language animation to support patient information before ILR implant was developed ( and we assessed patient understanding and engagement before and after introducing the animation into the consent pathway.

Methods: Patents having ILR implant in the out-patient clinic were prospectively surveyed on the day of their procedure, before (no animation group) and after (animation group) introducing the animation into the consent pathway. Standard care in the no animation group involved a consultant clinic consultation, a referral letter for procedure, phoned by admin to arrange appointment and sent a uni-lingual appointment letter via post or email (if email available). In the animation group, in addition to standard care, patients’ emails were emailed a link to the multilingual animation, which they could view often as needed. In the survey, patients were asked to respond to 3 questions relating to (i) the quality of information provided, (ii) their understanding of the information, and (iii) their involvement in the decision to proceed, each using a 5-point Likert scale. Results were examined by visual inspection and analyzed using Wilcoxon Rank Sum test. An additional 4 questions were asked of the animation group to assess the extent to which the animation supported patient understanding of the procedure, its benefits, risks and alternatives. Patients were asked to choose from one of 3 responses (complete understanding, partial understanding, no understanding).

Results: Surveys were completed from February 2020- May 2021, with a break in activity due cessation of elective work during the pandemic. A total of 103 consecutive patients were surveyed, 72 in the no animation group and 31 in the animation group. Table 1 shows the patient characteristics. Figure 1 displays the results of the comparative analysis, which showed a highly statistically significant improvement in the quality of information and patient understanding (p<0.001 and p=0.004) in the animation group compared with the no animation group, but not for patient involvement in decision-making (p=0.324). Among the animation group, complete understanding of the procedure, its benefits, risks and alternatives was reported in 84%, 87%, 81% and 52%, respectively.

Conclusion: Introduction of a multi-language pre-implant animation into the consent pathway was feasible, supported out-patient implant by non-medical staff and substantially improved patient-reported quality of information and understanding. Patients who watched the animation reported high levels of understanding of the procedure, its benefits, risks and alternatives. Consideration should be given to routinely offering the animation along with all referrals for ILR implant.

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