Inpatient Rehabilitation Outcomes for Patients Receiving Left Ventricular Assist Device

Alsara, Osama; Reeves, Ronald K.; Pyfferoen, Mary D.; Trenary, Tamra; Engen, Deborah J.; Vitse, Merri L.; Kessler, Stacy M.; Kushwaha, Sudhir S.; Clavell, Alfredo L.; Thomas, Randal J.; López-Jiménez, Francisco; Perez‐Terzic, Carmen

doi:10.1097/phm.0000000000000101

Cited by 26 publications

(16 citation statements)

References 9 publications

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“…The largest driver of differences in utilization of post-acute care services were hospital characteristics, as use was more common in patients who had LVADs implanted in larger hospitals in more populated areas and in the Northeast, possibly reflecting differences in availability of these services. Inpatient rehabilitation, in particular, is available on-site at some large academic centers(6, 12), and in those circumstances can be utilized in as many as half of patients after LVAD. Patients participating in inpatient rehabilitation programs after LVAD have been demonstrated to have substantial improvements in their functional ability by discharge(6, 12), though the benefits of rehabilitation in this setting have not been assessed in a controlled or randomized fashion.…”

Section: Discussionmentioning

confidence: 99%

Use of Post-acute Care Services and Readmissions After Left Ventricular Assist Device Implantation in Privately Insured Patients

Dunlay

Haas

Herrin

et al. 2015

Journal of Cardiac Failure

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Background Very little is known about healthcare resource utilization, including post-acute care use and hospital readmissions, following left ventricular assist device (LVAD) implantation. Methods and Results Administrative claims from a database of multiple U.S. health plans were used to identify patients that received an LVAD (ICD-9 code 37.66) and survived to hospital discharge from January 1, 2006 through September 30, 2013. Post-acute care use was defined as a skilled nursing facility or rehabilitation stay within 90 days after hospital discharge. Patients were censored at heart transplantation or end of coverage through December 31, 2013. Of 583 patients (mean age 55 years, 77% male), 223 (38.3%) utilized post-acute care services, which was more common in patients with diabetes, those who required hemodialysis, those who had LVADs implanted at hospitals in more populated areas, with more beds and in the Northeast region (p<0.05 for each). The most common reasons for readmission were device complications, heart failure, and arrhythmia. Readmission risk was higher in patients who had diabetes, peripheral vascular disease and longer hospital length of stay, but did not differ by post-acute care use. Conclusions Use of post-acute care services varies based on hospital characteristics. We found no association between post-acute care use and readmission risk after LVAD.

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Section: Discussionmentioning

confidence: 99%

Use of Post-acute Care Services and Readmissions After Left Ventricular Assist Device Implantation in Privately Insured Patients

Dunlay

Haas

Herrin

et al. 2015

Journal of Cardiac Failure

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“…Cardiac rehabilitation (CR) can and should make an important contribution in this context (3,4). After being discharged from a CR center the patients should once more become able to autonomously manage the necessary tasks in their everyday lives back home.Over the last few years, several studies have emerged, most of them small, which report results following rehabilitation (5)(6)(7)(8)(9)(10)(11)(12)(13)(14). In these studies, physical performance at the end of CR was evaluated using different measuring techniques (functional independence measures [FIM], treadmill ergometry, bicycle ergometry, strength tests, and 6-min walk test [6MWT]).…”

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confidence: 99%

Exercise Capacity and Functional Performance in Heart Failure Patients Supported by a Left Ventricular Assist Device at Discharge From Inpatient Rehabilitation

et al. 2017

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Adequate physical and functional performance is an important prerequisite for renewed participation and integration in self-determined private and (where appropriate) professional lives following left ventricular assist device (LVAD) implantation. During cardiac rehabilitation (CR), individually adapted exercise programs aim to increase exercise capacity and functional performance. A retrospective analysis of cardiopulmonary exercise capacity and functional performance in LVAD patients at discharge from a cardiac rehabilitation program was conducted. The results from 68 LVAD patients (59 males, 9 females; 55.9 6 11.7 years; 47 HVAD, 2 MVAD, 15 HeartMate II, 4 HeartMate 3, and 4 different implanting centers) were included in the analysis. Exercise capacity was assessed using a cardiopulmonary exercise test on a bicycle ergometer (ramp protocol; 10 W/min). The 6-min walk test was used to determine functional performance. At discharge from CR (53 6 17 days after implantation), the mean peak work load achieved was 62.2 6 19.3 W (38% of predicted values) or 0.79 6 0.25 W/kg body weight. The mean cardiopulmonary exercise capacity (relative peak oxygen uptake) was 10.6 6 5.3 mL/kg/min (37% of predicted values). The 6-min walk distance improved significantly during CR (325 6 106 to 405 6 77 m; P < 0.01). No adverse events were documented during CR. The results show that, even following LVAD implantation, cardiopulmonary exercise capacity remains considerably restricted. In contrast, functional performance, measured by the 6-min walk distance, reaches an acceptable level. Light everyday tasks seem to be realistically surmountable for patients, making discharge from inpatient rehabilitation possible. Long-term monitoring is required in order to evaluate the situation and how it develops further. Key Words: Heart failure-Left ventricular assist deviceCardiac rehabilitation-Exercise capacity-Functional performance.In the last few years, left ventricular assist devices (LVADs) have been increasingly implanted as treatment for terminal heart failure (HF). Whereas initially these systems were only used as a bridge to transplantation (BTT), today approximately half of all recipients have them implanted as the ultimate destination therapy (DT) (1).The overriding therapeutic goal of LVAD implantation is to ensure patient survival and guarantee preservation of organ function (2). However, when patients become permanently dependent on the system, a return to everyday life and restoration of an acceptable quality of life acquire crucial significance. An optimum build-up of exercise capacity and adequate functional performance is therefore very significant. Cardiac rehabilitation (CR) can and should make an important contribution in this context (3,4). After being discharged from a CR center the patients should once more become able to autonomously manage the necessary tasks in their everyday lives back home.Over the last few years, several studies have emerged, most of them small, which report results following rehabilitat...

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“…21 After 7 to 12 days in the inpatient rehabilitation unit, most patients experience a positive change in their functional status, with an increment in their mean total Functional Independence Measure scale score of 18 to 22 points. 21,22 Team-based Care of Long-term Left Ventricular Assist Device Support Implications of team-based care on long-term left ventricular assist device support The accelerated increase in the number of implanting centers and patients receiving an LVAD, 6 along with mounting efforts to maximize efficiency and limit unnecessary consumption of health care resources, has brought into question the costeffectiveness of this therapy. 23 The costs associated with LVAD therapy include those related to LVAD implant hospitalization, costs related to complications after LVAD implantation, and costs related to heart transplant in eligible patients.…”

Section: Team-based Care Of Left Ventricular Assist Device Supported mentioning

confidence: 99%

Team-based Care for Advanced Heart Failure

Wever-Pinzon

Drakos

Fang

2015

Heart Failure Clinics

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Inpatient Rehabilitation Outcomes for Patients Receiving Left Ventricular Assist Device

Cited by 26 publications

References 9 publications

Use of Post-acute Care Services and Readmissions After Left Ventricular Assist Device Implantation in Privately Insured Patients

Use of Post-acute Care Services and Readmissions After Left Ventricular Assist Device Implantation in Privately Insured Patients

Exercise Capacity and Functional Performance in Heart Failure Patients Supported by a Left Ventricular Assist Device at Discharge From Inpatient Rehabilitation

Team-based Care for Advanced Heart Failure

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