Findings presented at the American College of Cardiology (ACC) Quality Summit 2022 indicate that YouTube videos pertaining to implantable cardioverter defibrillators (ICDs) are of low and extremely variable quality. As more patients use the internet to learn about medicine, the study found that medical institutions could help patients by finding out what information they are getting online and how they can make online resources better in the future.

The study lead author Thomas Lee says, “patients are likely seeking out information about their medical conditions and procedures online primarily due to convenience and familiarity with the internet, particularly YouTube.” 

“Most people,” according to the author, “only have limited time to talk to a clinician about an ICD placement, so it would make sense that they would take to the internet to learn more about it.”

The author adds: “While we can’t stop our patients from getting information online, nor would we want to curtail their access to information about their conditions, it is important that the medical community work to ensure higher quality information that provides a full picture of a treatment or procedure is available.”

Researchers say that information about how people use the internet shows that 80% of people look for health information online and 56% look for information about medical treatments or procedures. In 2020, 40% of Americans, according to a recent Health Information National Trends Survey, viewed YouTube videos for health and medical information.

In this study, researchers used YouTube to search for videos relating to implantable cardioverter defibrillators before filtering out lecture-style videos, surgical and/or operating room videos, non-English language videos without subtitles, videos with irrelevant content, audio-only videos, duplicates, and videos with other language options. 25 of the first 75 videos found were disqualified. The remaining 50 were classified according to the kind of uploader: academic institution (29), medical device corporation (13), and independent uploader (8).

The video quality was evaluated using modified DISCERN criteria (range: 0-25), which were developed to assist patients in evaluating information about treatment alternatives and are used in patient-education literature to assess overall quality, bias, and reliability of content. Based on past studies, the cut-offs for qualitative scores were: very poor (<9), poor (9–13), average (14–17), good (18–21), and excellent (22-25). An electrophysiologist-reviewed Novel Content Score (range: 0-10) was also used to evaluate video quality. This score was supposed to represent the information an electrophysiologist would present to a patient seeking an ICD operation. Similar cut-offs for qualitative scores were included: very low (0-2.5), poor (2.6-40), average (4.1-6.0), good (6.1-8.0), and exceptional (8.1-10). Views, likes, duration, days since upload, and comments were among the secondary outcomes used by the researchers to assess the popularity of videos.

Overall, both scoring systems revealed that the evaluated videos were of poor quality and had a wide range of ratings. The adjusted DISCERN score on average was 12.58, and the novel content score on average was 3.68. When compared to university institutions and individual uploaders, the researchers discovered that clips posted by medical device firms had much lower adjusted DISCERN scores. The Novel Content Score and earlier search result position significantly correlated positively, but not with the modified DISCERN score. Additionally, there was a strong positive link between the length of the videos and both rating factors. There is no correlation between any of the video popularity indicators and video quality.

As more patients turn to online resources for patient education, the study, according to the researchers, shows an opportunity for medical institutions to assist patients by using innovative tactics to increase video content, quality, and visibility. For instance, researchers discovered that most of the videos did not address inappropriate shock as a potential consequence of ICDs.

“It’s so important that patients have access to high quality information because of how challenging it can be to interact with medical professionals. Oftentimes a patient will have to wait weeks or even months before they can confidently have their questions answered,” adds Lee. “The issue is that on YouTube so much of the informative videos seem like they’re high quality because of a hospital setting or doctor narrating, but in reality, the video fails to convey the complete picture of an ICD placement.”

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