Video helps defibrillator patients make informed choices
Educational initiative addresses critical gap in care, spurring conversations about heart device management, UTSW researchers report
DALLAS – Feb. 26, 2025 – A UT Southwestern Medical Center quality improvement team led a large-scale, multispecialty project in partnership with the Parkland Center of Innovation and Value to help patients with implantable cardioverter defibrillators (ICDs) better understand their devices and make choices about their care. The findings, published in Circulation: Cardiovascular Quality and Outcomes, highlight how a structured approach to patient education can empower individuals to discuss their treatment options with providers and ensure care aligns with their goals, particularly near the end of life.
“By educating patients appropriately, this work allows patients to make informed decisions regarding their implanted defibrillators and how they want to live in a manner that benefits their goals and values,” said study leader Melanie Sulistio, M.D., Professor of Internal Medicine in the Division of Cardiology at UT Southwestern.
ICDs detect abnormal heart rhythms and restore normal function with electric shocks, which can be lifesaving but also distressing, especially for patients approaching the end of life. While medical guidelines recommend discussing ICD settings – including shock adjustments and deactivation – during advance care planning, many patients never receive this information, leaving them unaware of their options.
The researchers developed a video to provide patients with important, accessible information about ICD management. The initiative reflects UT Southwestern’s commitment to improving patient care and builds on previous research showing that cancer patients with ICDs were more likely to receive aggressive end-of-life care than those without the devices.
All study participants were patients in 2023 at Parkland Health, a public safety-net health system that serves as the primary teaching hospital for UTSW. Parkland Health supports a diverse patient population, many of whom face barriers to care, such as language differences and health literacy challenges.
The seven-plus-minute video, available in English and Spanish, explains ICD function in clear, relatable terms. It uses effective analogies, comparing an ICD to a fire alarm that remains inactive under normal conditions but is triggered in an emergency. The video also illustrates what an ICD shock feels like, why patients might consider adjusting their settings, and how to start a conversation with their doctor about their options.
The study tested the video with 50 patients at Parkland Health, assessing their knowledge before and after watching. Before viewing, only 47% of patients correctly answered key questions about ICD function and shock settings. Afterward, that number increased to 81%, demonstrating a significant improvement in understanding. Every patient rated the video as “helpful” or “very helpful.”
Counting both the English and Spanish versions, the video has been viewed more than 1,000 times, with its use growing across cardiology, palliative care, and outpatient clinics. Its potential impact extends beyond cardiovascular contexts, offering a valuable resource for individuals with various health conditions who also have an ICD.
“This can be applicable to a broad range of patients with heart disease but is also relevant to cancer patients, neurologic patients, and any patient who may have an ICD,” Dr. Sulistio explained.
UT Southwestern and Parkland Health plan to expand the video’s reach by integrating it into electronic health records, patient portals, and outpatient care settings. Embedding it into routine care could help more patients make ICD choices that reflect their wishes, foster autonomy, reduce unnecessary interventions, and improve end-of-life care.
Other UTSW researchers in Internal Medicine who contributed to this study include first author Christine L. Chen, M.D., graduate of UT Southwestern Medical School and now an Internal Medicine resident at Mayo Clinic in Rochester, Minnesota; Kelley Newcomer, M.D., Assistant Professor in the Division of General Internal Medicine in Palliative Medicine; Nainesh Shah, M.D., Clinical Associate Professor; Nimesh S. Patel, M.D., Assistant Professor; Sarah Godfrey, M.D., M.P.H., a clinical fellow; residents Jingwen Zhang, M.D., and Christopher Viamontes, M.D., M.A.; medical student Nakul Patel, B.A.; Megan Kelly, APP; and Brenden Garrett, M.D., a graduate of UT Southwestern Medical School. Kristin Alvarez, Pharm.D., Director of Clinical Innovation at the Center of Innovation and Value at Parkland Health, also contributed to this study.
About UT Southwestern Medical Center
UT Southwestern, one of the nation’s premier academic medical centers, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty members have received six Nobel Prizes and include 25 members of the National Academy of Sciences, 23 members of the National Academy of Medicine, and 14 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 3,200 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in more than 80 specialties to more than 120,000 hospitalized patients, more than 360,000 emergency room cases, and oversee nearly 5 million outpatient visits a year.
About Parkland Health
Parkland Health is one of the largest public hospital systems in the country. Premier services at the state-of-the-art Parkland Memorial Hospital include the Level I Rees-Jones Trauma Center, the only burn center in North Texas verified by the American Burn Association for adult and pediatric patients, and a Level III Neonatal Intensive Care Unit. The system also includes two on-campus outpatient clinics – the Ron J. Anderson, MD Clinic and the Moody Outpatient Center, as well as more than 30 community-based clinics and numerous outreach and education programs. By cultivating its diversity, inclusion, and health equity efforts, Parkland enriches the health and wellness of the communities it serves. For more information, visit parklandhealth.org.