Michael Yaoyao Yin1, Jennifer Strege2, Edward M Gilbert1, Josef Stehlik1, Stephen H McKellar3, Ashley Elmer4, Thomas Anderson1, Mossab Aljuaid1, Jose Nativi-Nicolau1, Antigone G Koliopoulou5, Erin Davis4, James C Fang1, Stavros G Drakos1, Craig H Selzman5, Omar Wever-Pinzon6. 1. Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah. 2. Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Department of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah. 3. Department of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah. 4. Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Department of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah. 5. Department of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah. 6. Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah. Electronic address: omar.wever.pinzon@hsc.utah.edu.
Abstract
OBJECTIVES: The aim of this study was to evaluate the impact of a shared-care model on outcomes in patients with left ventricular assist devices (LVADs) living in remote locations. BACKGROUND: Health care delivery through shared-care models has been shown to improve outcomes in patients with chronic diseases. However, the impact of shared-care models on outcomes in patients with LVAD is unknown. METHODS: LVAD recipients in the authors' program (2007 to 2018) were classified based on the levels of care provided and training and resources used: level 1, was defined as outpatient primary care without LVAD-specific care; level 2 was level 1 services and outpatient LVAD-specific care; level 3 was level 2 services and inpatient LVAD-specific care and implantation center (IC). The Kaplan-Meier method was used to compare rates of survival, bleeding, pump thrombosis, infection, neurologic events, and readmissions among levels of care. RESULTS: A total of 336 patients were included, with 255 patients (75.9%) cared for in shared-care facilities. Median follow-up was 810 (interquartile range: 321 to 1,096) days. In comparison to patients cared for by IC, patients at levels 2 and 3 shared-care centers had similar rates of death, bleeding, neurologic events, pump thromboses, and infections. However, the rates of death, pump thromboses, and infections were higher for level 1 patients than in IC patients. CONCLUSIONS: Shared health care is an effective strategy to deliver care to patients with LVAD living in remote locations. However, patients in shared-care facilities unable to provide LVAD-specific care are at higher risk of unfavorable outcomes. Availability of LVAD-specific care should be strongly considered during patient selection and every effort made to ensure LVAD-specific training and resources are available at shared-care facilities.
OBJECTIVES: The aim of this study was to evaluate the impact of a shared-care model on outcomes in patients with left ventricular assist devices (LVADs) living in remote locations. BACKGROUND: Health care delivery through shared-care models has been shown to improve outcomes in patients with chronic diseases. However, the impact of shared-care models on outcomes in patients with LVAD is unknown. METHODS: LVAD recipients in the authors' program (2007 to 2018) were classified based on the levels of care provided and training and resources used: level 1, was defined as outpatient primary care without LVAD-specific care; level 2 was level 1 services and outpatient LVAD-specific care; level 3 was level 2 services and inpatient LVAD-specific care and implantation center (IC). The Kaplan-Meier method was used to compare rates of survival, bleeding, pump thrombosis, infection, neurologic events, and readmissions among levels of care. RESULTS: A total of 336 patients were included, with 255 patients (75.9%) cared for in shared-care facilities. Median follow-up was 810 (interquartile range: 321 to 1,096) days. In comparison to patients cared for by IC, patients at levels 2 and 3 shared-care centers had similar rates of death, bleeding, neurologic events, pump thromboses, and infections. However, the rates of death, pump thromboses, and infections were higher for level 1 patients than in IC patients. CONCLUSIONS: Shared health care is an effective strategy to deliver care to patients with LVAD living in remote locations. However, patients in shared-care facilities unable to provide LVAD-specific care are at higher risk of unfavorable outcomes. Availability of LVAD-specific care should be strongly considered during patient selection and every effort made to ensure LVAD-specific training and resources are available at shared-care facilities.
Authors: Binyamin Ben Avraham; Marisa Generosa Crespo-Leiro; Gerasimos Filippatos; Israel Gotsman; Petar Seferovic; Tal Hasin; Luciano Potena; Davor Milicic; Andrew J S Coats; Giuseppe Rosano; Frank Ruschitzka; Marco Metra; Stefan Anker; Johann Altenberger; Stamatis Adamopoulos; Yaron D Barac; Ovidiu Chioncel; Nicolaas De Jonge; Jeremy Elliston; Maria Frigeiro; Eva Goncalvesova; Avishay Grupper; Righab Hamdan; Yoav Hammer; Loreena Hill; Osnat Itzhaki Ben Zadok; Miriam Abuhazira; Jacob Lavee; Wilfried Mullens; Sanemn Nalbantgil; Massimo F Piepoli; Piotr Ponikowski; Arsen Ristic; Arjang Ruhparwar; Aviv Shaul; Laurens F Tops; Steven Tsui; Stephan Winnik; Tiny Jaarsma; Finn Gustafsson; Tuvia Ben Gal Journal: ESC Heart Fail Date: 2021-09-14
Authors: K Dennie Kim; Russell J Funk; Hechuan Hou; Austin Airhart; Khalil Nassar; Francis D Pagani; Min Zhang; P Paul Chandanabhumma; Keith D Aaronson; Carol E Chenoweth; Ahmad Hider; Lourdes Cabrera; Donald S Likosky Journal: Circ Cardiovasc Qual Outcomes Date: 2022-09-06
Authors: Kelsey Flint; Erin L Chaussee; Kamal Henderson; Khadijah Breathett; Prateeti Khazanie; Jocelyn S Thompson; Colleen K Mcilvennan; Shane J Larue; Daniel D Matlock; Larry A Allen Journal: J Card Fail Date: 2020-12-18 Impact factor: 5.712