Outcomes of Acute Inpatient Rehabilitation in Patients with Left Ventricular Assist Devices

Chu, Samuel Kai Wah; McCormick, Zachary L; Hwang, Sarah; Rydberg, Leslie

doi:10.1016/j.pmrj.2013.08.035

Cited by 9 publications

(13 citation statements)

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“…Acute inpatient rehabilitation after LVAD placement has not been studied extensively. Prior studies, by Nguyen and Stein [9] and Chu et al, [10] and English and Speed [11] have evaluated FIM scores and LOS, which demonstrated similar results as our study. However, no study has gone deeper into the complications that could impact the length of stay which, in turn, affects the functional gains.…”

Section: Discussionsupporting

confidence: 89%

Functional Outcomes in Patients with a Left Ventricular Assist Device

Poduri¹

2015

PMRD

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Background: To evaluate functional outcomes of patients with a Left Ventricular Assist Device (LVAD) with cardiac failure by using Functional Independence Measure (FIM) and to determine whether age and co-morbid conditions impact their outcomes. Methods:This was a retrospective study of patients with LVADs who underwent acute inpatient rehabilitation at a tertiary care hospital from 2010 to 2014. Their age, admission and discharge FIM, FIM gains, Length of Stay (LOS), Efficiency Ratios (ER), and comorbid conditions were gathered. Time from LVAD placement to rehabilitation admission is variable depending on patients' ability to endure the acute rehabilitation process. Correlation coefficients for these characteristics were calculated and Student's t-test conducted with p value set at <0.05 for significance. We assessed the association between age, comorbid conditions and functional gains in LVAD patients. Results:The average age of patients was 62 years (range, 36-79 years). The mean admission and discharge FIM scores were 76.56 and 96.69 respectively. The mean FIM gain was 20 (range, -8 to 39). The mean length of stay was 15 days (range, 6-23 days). The mean ER (FIM gain over LOS) was 1.5. The highest and lowest ERs were that of a 61 year old and a 43 year old, respectively. Comorbid conditions did not influence the functional gains, because most individuals had similar problems and did not lose any time during their rehabilitation due to their medical instability. Conclusion:Overall, patients did well enough to be discharged home. Independent of age, admission FIM was significantly associated with LOS. Age and comorbidities did not appear to have a great impact on the FIM gains and/or ER in LVAD patients going through acute inpatient rehabilitation.

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Section: Discussionsupporting

confidence: 89%

Functional Outcomes in Patients with a Left Ventricular Assist Device

Poduri¹

2015

PMRD

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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]).…”

mentioning

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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“…However, the number of organs available for transplant is lower than the demand [4,5]. Another treatment option in advanced heart failure is mechanical ventricular support, which can be offered to patients who meet pre-determined criteria for inclusion [6]. The most commonly surgically implanted device is left-ventricular assistance device.…”

Section: Introductionmentioning

confidence: 99%

“…These patients are subject to very long periods of hospitalization, because their condition must be stable and they must be able to handle the replacement of external batteries before being discharged to home. These patients have to undergo strict medical supervision and can access the cardiovascular rehabilitation programs; the results of functional recovery are very slow but verifiable [6,[9][10][11]. The patient with L-VAD system is subject to a number of complications both during the hospital stay, and at home, in particular anemia, respiratory problems, recurrent infections in the insertion of the VAD cable, and on rare occasions, thrombosis [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…These patients have to undergo strict medical supervision and can access the cardiovascular rehabilitation programs; the results of functional recovery are very slow but verifiable [6,[9][10][11]. The patient with L-VAD system is subject to a number of complications both during the hospital stay, and at home, in particular anemia, respiratory problems, recurrent infections in the insertion of the VAD cable, and on rare occasions, thrombosis [5][6][7]. In this study we evaluated the presence of osteopathic dysfunctions in patients with L-VAD, as we have verified that a text citing osteopathic issues is missing from the existing literature.…”

Section: Introductionmentioning

confidence: 99%

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