Outpatient left ventricular assist device support: a safe and economical therapeutic option for heart failure.
The left ventricular assist device (LVAD), once considered for acute cardiac failure only when no other therapeutic option was available, is now used routinely at selected centers to allow the sickest patients to become self-sufficient and go home. This represents a dramatic change in the physician's perception of the LVAD in the early 1990s. The creation of these mechanical assist outpatient programs are possible for the following reasons: 1) confidence in the devices allow patients, their families, and health care providers to be more comfortable with outpatient therapy; 2) the devices are simplified and durable, allowing extended duration of support and more options for patients; and 3) a change in the perception of the LVAD from a last-resort therapeutic option to that of a safe and reliable bridge to recovery and transplant. With these general concepts in mind, programs have been created with specific safety nets, patient education goals, and discharge criteria. By using this construct, we have developed a successful outpatient LVAD program in which 70% of our vented electric LVAD patients were discharged with a 0% mortality and minimal morbidity. From our experience and studies, we believe that not only is an outpatient LVAD program safe and economical, but it is also socially, physically, and psychologically beneficial to the patient. In the current economic environment of cost containment, outpatient LVAD therapy is a necessary part of an LVAD program that should be sought by most cardiac mechanical assist programs.
Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, NY, USA. dlm36@Columbia.edu
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Morales
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Argenziano
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D000553:Ambulatory Care / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D004869:Equipment Safety; D006333:Heart Failure / Q000601:surgery*; D006353:Heart-Assist Devices / Q000191:economics / Q000592:standards; D006801:Humans; D010349:Patient Compliance; D010353:Patient Education as Topic; D015397:Program Evaluation; D011788:Quality of Life; D016896:Treatment Outcome