Clinical outcomes of inpatient cardiac rehabilitation for patients with treated left ventricular assist device in Korea: 1-year follow-up

Abstract

In Korea, the first patient with a left ventricular assist device (LVAD) for destination therapy had successful implantation of a continuous-flow model in 2012. We investigated the safety and efficacy of exercise therapy with LVAD implantation 15 Korean patients. We retrospectively reviewed 15 patients (mean age, 67.4±11.6 years; 10 males, 5 female, left ventricular ejection fraction 23.6%±7.1%), including 4 with implanted continuous-flow and 11 an axial-flow LVAD. The New York Heart Association functional classification, ejection fraction, and quality of life were obtained. Survival rate, adverse events, admission rates, and enrollment rates in cardiac rehabilitation were investigated. Survival at 6 and 12 months was 100% and 89%, respectively. The New York Heart Association functional classification improved from 3.4±0.5 to 2.3±0.05 at 12 months postoperatively ( P <0.0001). The ejection fraction significantly increased from 23.6%±7.2% on the preoperative day to 35.4%±14.2% at 1 year ( P <0.0018). The quality of life was also improved at 1 year ( P <0.0001). The most common adverse events were bleeding (56%) and dyspnea (44%). The number of admissions was 3.2 per patient-year. LVAD therapy is a safe and effective treatment option with exercise intervention for Korean patients waiting for heart transplantation or those who were ineligible for heart transplantation. A larger study with longer follow-up is needed to determine details clinical outcomes after LVAD.

Barriers and Facilitators to Delivering Inpatient Cardiac Rehabilitation: A Scoping Review

“…Financial Costs and Resource Limitations: Broadly speaking, inadequate funding and resources both negatively influenced the ability to access and deliver ICR. 39 , 70 , 80 , 99 , 108 , 130 , 142 , 164 , 166 , 199 , 201 , 207 , 209–211 Vincent et al 145 and Schweikert et al 128 reported that it cost their institutions $4709 USD and €3388 EUR for total therapy charges per patient, respectively. Costs are significantly higher for those who require ICR in comparison to outpatient or community-based rehabilitation.…”

“…This often occurred when CR facilities and programs were limited and inaccessible, such as in rural regions. 39 , 70 , 80 , 99 , 108 , 130 , 142 , 164 , 166 , 199 , 201 , 207 , 209–211 …”

“…28,39,166,200,206 Provider Level Provider Knowledge and Efficacy: Studies indicate that providers lack expertise and interest in ICR 131,152,166,206 and have limited knowledge about the types of ICR interventions that exist and their importance and benefit. 39,58,70,80,84,99,108,113,130,142,164,166,168,199,201,[206][207][208][209][210][211] Further, many of them have difficulty forming new concepts and skills to implement novel interventions 84 and are challenged by time/scheduling restrains as well as narrow scopes of practice when it comes to implementing ICR. 51,78,108,124,142,201,207,209,210 Team Functioning: The absence of strong social networks impacted program delivery.…”

Early Postoperative Cardiac Rehabilitation in LVAD Patients: A Case Report

“…Both domestic and international studies indicate that Phase I exercise rehabilitation can commence within the first 3 days post-LVAD implantation, specifically in the ICU. The initiation can occur as soon as the patient is awake and exhibits hemodynamic stability post-surgery [12][13][14]. For patients post-LVAD implantation during hospitalization, it is recommended to refer to the advanced intensive rehabilitation assessment and treatment plan from the University Hospitals Leuven Medical School [15].…”

Outcomes of Patients Referred for Cardiac Rehabilitation After Left Ventricular Assist Device Implantation

“…[8][9][10] Despite the number of LVADs implanted, safety data on CR participation and outcomes are limited to several small studies and a meta-analysis of 125 patients. [10][11][12][13][14][15][16][17][18][19][20] The purpose of the present analysis was to add to existing data and assess the outcomes of LVAD recipients referred for CR using a large, single-center continuous-flow LVAD cohort.…”