The pharmacotherapy of the HeartMate II, a continuous flow left ventricular assist device, in patients with advanced heart failure: integration of disease, device, and drug.
Advanced heart failure continues to be a significant cause of morbidity and mortality in the US. Patients with advanced heart failure have a poor prognosis without cardiac transplantation. The use of left ventricular assist devices (LVADs) as destination therapy for these patients is therefore expected to increase in the coming years as technology advances. The HeartMate II, a continuous flow implantable device, is currently the only LVAD that has been approved by the Food and Drug Administration for destination therapy in patients with advanced heart failure. The pharmacotherapy associated with this device is very complex and, therefore, the need for expertly trained clinical pharmacists to care for this expanding patient population will also likely increase. Unfortunately, most pharmacists are unfamiliar with the effect of LVADs on the physiology and pharmacotherapy of a patient's heart failure. The purpose of this article is to give clinical pharmacists an introduction to the most common pharmacotherapeutic issues for patients with LVADs and present practical solutions for managing common drug therapy problems.
Jennings
Douglas L
DL
Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA. djennin1@hfhs.org
Chambers
Rachel M
RM
Schillig
Jessica M
JM
D000890:Anti-Infective Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D010353:Patient Education as Topic; D010593:Pharmaceutical Services; D010595:Pharmacists; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D024382:Professional Role; D019919:Prosthesis Implantation / Q000379:methods; D016459:Prosthesis-Related Infections / Q000517:prevention & control; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery
D000890:Anti-Infective Agents; D000925:Anticoagulants