Author + information
- Received December 16, 2019
- Revision received January 2, 2020
- Accepted January 3, 2020
- Published online March 30, 2020.
- Michael Yaoyao Yin, MDa,c,
- Jennifer Strege, NP-Ca,b,c,
- Edward M. Gilbert, MDa,c,
- Josef Stehlik, MD, MPHa,c,
- Stephen H. McKellar, MDb,c,
- Ashley Elmer, MSa,b,
- Thomas Anderson, MDa,c,
- Mossab Aljuaid, MDa,c,
- Jose Nativi-Nicolau, MDa,c,
- Antigone G. Koliopoulou, MDb,
- Erin Davis, BSNa,b,
- James C. Fang, MDa,c,
- Stavros G. Drakos, MD, PhDa,c,
- Craig H. Selzman, MDb and
- Omar Wever-Pinzon, MDa,c,∗ ()
- aDepartment of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
- bDepartment of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
- cGeorge E. Wahlen Veterans’ Affairs Medical Center, Salt Lake City, Utah
- ↵∗Address for correspondence:
Dr. Omar Wever-Pinzon, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100 SOM, Salt Lake City, Utah 84132.
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.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Drakos is supported by American Heart Association Heart Failure Strategically Focused Research Network grant 16SFRN29020000, by U.S. National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute grants R01 HL135121-01 and R01 HL132067-01A1, and by the Nora Eccles Treadwell Foundation. Dr. Wever-Pinzon is supported by University of Utah Program in Personalized Health and National Center for Advancing Translational Sciences of the NIH award 1UL1TR002538. Dr. Stehlik is a consultant for Medtronic and Abbott. Dr. Drakos is a consultant for and a member of the steering committee for Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 16, 2019.
- Revision received January 2, 2020.
- Accepted January 3, 2020.
- 2020 American College of Cardiology Foundation
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