Quality of Life and Influential Factors in Patients Implanted With a Left Ventricular Assist Device

Kato, Naoko; Okada, Ikuko; Imamura, Teruhiko; Kagami, Yukie; Endo, Miyoko; Nitta, Daisuke; Fujino, Takeo; Muraoka, Hironori; Minatsuki, Shun; Maki, Hisataka; Inaba, Toshiro; Katoh, Osamu; Nawata, Kan; Hatano, Masaru; Yao, Atsushi; Kyo, Shunei; Ōno, Minoru; Jaarsma, Tiny; Kinugawa, Koichiro

doi:10.1253/circj.cj-15-0502

Cited by 26 publications

(32 citation statements)

References 27 publications

(16 reference statements)

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“…There were no significant differences in median baseline overall KCCQ (HM3: 40 [ [8][9][10][11][12][13][14][15], p ¼ 0.71) scores between HM3 and HMII devices. At 3 and 6 months of follow-up, patients demonstrated a significant improvement in KCCQ and in overall EQ-5D-5L scores compared with baseline (p o 0.001 for within-patient comparison, Figure 2).…”

Section: Hr-qol and Fcmentioning

confidence: 87%

“…Clinical trials and registry studies have shown that most patients experience early and sustained improvements in FC and HR-QOL after LVAS implant. [6][7][8][9][10][11][12][13][14] However, an analysis of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) by Arnold et al 6 found that 7.3% of patients alive on LVAS support have persistently poor QOL. Various correlates of reduced QOL gains have been identified, including female sex, age, baseline QOL scores, pre-operative anemia, non-cardiac comorbidities (diabetes, cancer), and the occurrence of complications after LVAS implant.…”

Section: Introductionmentioning

confidence: 99%

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Quality of life and functional capacity outcomes in the MOMENTUM 3 trial at 6 months: A call for new metrics for left ventricular assist device patients

Cowger

Naka

Aaronson

et al. 2018

The Journal of Heart and Lung Transplantation

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Section: Hr-qol and Fcmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Quality of life and functional capacity outcomes in the MOMENTUM 3 trial at 6 months: A call for new metrics for left ventricular assist device patients

Cowger

Naka

Aaronson

et al. 2018

The Journal of Heart and Lung Transplantation

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“…DT-LVAD has been shown to decrease mortality compared with medical therapy 1 , and can result in improved quality of life for many patients 1, 2 . While DT-LVAD can prolong survival for many patients with advanced HF, all patients will eventually die.…”

mentioning

confidence: 99%

Dying With a Left Ventricular Assist Device as Destination Therapy

Dunlay

Strand

Wordingham

et al. 2016

Circ: Heart Failure

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Background Despite the ability of left ventricular assist device as destination therapy (DT-LVAD) to prolong survival for many patients with advanced heart failure (HF), little is known about the eventual end-of-life care that patients with DT-LVAD receive. Methods and Results All patients undergoing DT-LVAD at the Mayo Clinic in Rochester, Minnesota from January 1, 2007 through September 30, 2014 who subsequently died prior to July 1, 2015 were included. Information about end-of-life care was obtained from documentation in the electronic medical record. Of 89 patients that died with a DT-LVAD, the median (25th–75th percentile) time from LVAD implantation to death was 14 (4–31) months. The most common causes of death were multiorgan failure (26%), hemorrhagic stroke (24%), and progressive HF (21%). Nearly half (46%) of patients saw palliative care within one month prior to death; however, only 13 (15%) patients enrolled in hospice a median 11 (range 1–315) days prior to death. Most patients (78%) died in the hospital, of which 88% died in the intensive care unit. In total, 49 patients had their LVAD deactivated prior to death, with all but 3 undergoing deactivation in the hospital. Most patients died within an hour of LVAD deactivation, and all within 26 hours. Conclusions In contrast to the general HF population, most patients with DT-LVAD die in the hospital and very few utilize hospice. Further work is needed to understand these differences and to determine whether patients with DT-LVAD are receiving optimal end-of-life care.

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“…From 2009 to 2012, the median risk-standardised 30-day readmission rate for HF was 23.0% 5. The overall implications of HF include a negative impact on patients’ quality of life, increased morbidity and mortality, and increased number of avoidable hospitalisations 6–8…”

Section: Introductionmentioning

confidence: 99%

Optimisation of diagnosis and treatment of heart failure in a primary care setting

et al. 2019

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BackgroundHeart failure (HF) is one of the leading causes of emergency department visits and hospital admissions in the USA. We identified a gap in the diagnosis and the use of guideline-directed medical therapy in patients with HF at the internal medicine clinic.AimTo improve the diagnosis and treatment of HF, as well as to reduce emergency department visits and hospitalisation over 12 months in patients aged 40–75 years.MethodsThe multidisciplinary quality improvement (QI) team performed a root cause analysis and identified barriers to optimal guideline-directed medical therapy. Rates of patients on guideline-directed medical therapy with systolic HF diagnosis, emergency department visits and hospital admissions were the outcome measures. The process measures included echocardiogram order and completion rates, and rates of accurate classification of HF from the baseline rate of less than 10%. We used the focus, analyse, develop, execute and evaluate (FADE) model with five improvement cycles. The major components of interventions included (1) leveraging health information technology; (2) optimising teamwork; and (3) providing education to patients, physicians and internal medicine clinic staff. Data were analysed using statistical process control and run charts.ResultsWe observed a reduction in the total number of emergency department visits (160 vs 108), hospital admissions (117 vs 114) and observation visits (22 vs 16) comparing the 1-year preproject and 1-year postproject periods. An increase in the use of ACE inhibitors or angiotensin receptor blockers occurred from the baseline rate of 20%–37% during the second half of the project and was sustained at 71.4% (median) during 6 months of the postproject period.ConclusionsWe achieved a sustainable increase in the accurate diagnosis of HF and achieved 80% diagnosis during the 6-month poststudy period.

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Quality of Life and Influential Factors in Patients Implanted With a Left Ventricular Assist Device

Cited by 26 publications

References 27 publications

Quality of life and functional capacity outcomes in the MOMENTUM 3 trial at 6 months: A call for new metrics for left ventricular assist device patients

Quality of life and functional capacity outcomes in the MOMENTUM 3 trial at 6 months: A call for new metrics for left ventricular assist device patients

Dying With a Left Ventricular Assist Device as Destination Therapy

Optimisation of diagnosis and treatment of heart failure in a primary care setting

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