Implementation of an intensified outpatient follow-up protocol improves outcomes in patients with ventricular assist devices

• Verfasst von: Hamed, Sonja [VerfasserIn]
• Verfasst von: Schmack, Bastian [VerfasserIn]
• Verfasst von: Ehlermann, Philipp [VerfasserIn]
• Verfasst von: Ruhparwar, Arjang [VerfasserIn]
• Verfasst von: Katus, Hugo [VerfasserIn]
• Verfasst von: Raake, Philip [VerfasserIn]
• Verfasst von: Kreußer, Michael [VerfasserIn]
• Titel: Implementation of an intensified outpatient follow-up protocol improves outcomes in patients with ventricular assist devices
• Verf.angabe: Sonja Hamed, Bastian Schmack, Florian Mueller, Philipp Ehlermann, Davina Hittmann, Arjang Ruhparwar, Hugo A. Katus, Philip W. Raake, Michael M. Kreusser
• E-Jahr: 2019
• Jahr: 16 March 2019
• Umfang: 11 S.
• Fussnoten: Gesehen am 11.11.2019
• Titel Quelle: Enthalten in: Clinical research in cardiology
• Ort Quelle: Berlin : Springer, 2006
• Jahr Quelle: 2019
• Band/Heft Quelle: 108(2019), 11, Seite 1197-1207
• ISSN Quelle: 1861-0692
• DOI: doi:10.1007/s00392-019-01451-9
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Advanced heart failure
• Sach-SW: Follow-up protocol
• Sach-SW: Mechanical circulatory support
• Sach-SW: Outpatient care
• Sach-SW: Ventricular assist devices
• K10plus-PPN: 1681580888

Abstract

Background: Ventricular assist devices (VAD) are increasingly used as long-term treatment for advanced heart failure. However, survival after VAD implantation is still unsatisfactory, and no specific outpatient follow-up algorithms have been formally established. Here, we evaluate the effect of an intensified follow-up protocol (IFUP) on survival rates and VAD-associated complications. Methods and results: This is a retrospective study of 57 patients who received a VAD at our center between February 2013 and December 2017. Inclusion criteria were discharge home after VAD implantation and follow-up in our VAD outpatient clinic. Patients implanted after October 2015 (n = 30) were monitored according to IFUP. This protocol embodied formalized, multi-disciplinary clinical visits every 4-8 weeks including a cardiologist, a cardiothoracic surgeon and a VAD-coordinator and was characterized by optimized anticoagulation and wound management as well as guideline-directed medical therapy. One-year survival in the IFUP patients was 97%, compared to 74% in the pre-IFUP era (p = 0.01). Implementation of IFUP was associated with a 90% risk-reduction for 1-year mortality (relative risk 0.099; p = 0.048). The rate of complications, e.g., device thrombosis and major bleeding, was significantly reduced, resulting in superior event-free survival in the IFUP group (p = 0.003). Furthermore, by implementation of IFUP, a more stable anticoagulation adjustment was achieved as well as an improved adherence to guideline-directed medical therapy. Conclusion: Implementation of an IFUP for VAD patients is associated with a significant decrease in 1-year all-cause mortality. This emphasizes the need for more vigilance in the management of VAD patients by a dedicated multi-disciplinary team.