Acute Rehabilitation Is Effective in Patents with Left Ventricular Assist Device

Abstract

Background and AimAcute inpatient rehabilitation has minimally been studied in left ventricular assist device ((LVAD) patients. We studied the functional changes of patients with LVAD who received inpatient acute rehabilitation.MethodsWe performed an IRB-approved, retrospective review of all patients with LVAD who were admitted to our acute rehabilitation center (ARC) between 1/1/2012 and 08/31/2013, regardless of admission diagnosis. Demographics, medical comorbidities, reason for LVAD, length of stay (LOS), and FIM scores (Functional Independence score - uniform system of measurement for disability based on the International Classification of Impairment, Disabilities and Handicaps) on admission and discharge were recorded. Change in FIM scores and rehabilitation efficiency (change in FIM score/LOS) were analyzed.ResultsWe identified 30 males and 2 females with mean age (±SD) of 64±10.5 years. Half were implanted as bridge to transplant and 24 were admitted after initial implant. 2 patients were excluded as outliers as 1 was transferred back in less than 24 hrs, and another stayed for 40 days due to disposition issues. 6 out of 32 patients had to be readmitted to acute hospital due to complications (2 had firing of ICD, 2 had hypotension, 1 transferred due to concern for hemolysis and 1 transferred due to concern for clot), 2 were discharged to skilled nursing facility due to social situation and 24 were discharged home safely. Mean (±SD) LOS was 9.93(+/-4.84) days. The mean (±SD) FIM gain was statistically significant at 25.53 (+/- 10.36) (p <0.0001), and was comparable to regional (23.6) and national (27.8) mean for patients admitted to ARCs with any cardiac diagnosis. The mean (±SD) FIM efficiency (FIM gain/ARC LOS) was 2.90 (+/- 1.28) in comparison with the regional mean of 2.56 and national mean of 2.86.ConclusionRehabilitation following LVAD placement is critical to optimal outcomes. Despite a readmission rate of 19%, the majority went home with statistically significant improvement in their functional capacity, compared to national and regional standards for cardiac diseases. Acute rehabilitation should be considered in post LVAD patients before transitioning to home. Background and AimAcute inpatient rehabilitation has minimally been studied in left ventricular assist device ((LVAD) patients. We studied the functional changes of patients with LVAD who received inpatient acute rehabilitation. Acute inpatient rehabilitation has minimally been studied in left ventricular assist device ((LVAD) patients. We studied the functional changes of patients with LVAD who received inpatient acute rehabilitation. MethodsWe performed an IRB-approved, retrospective review of all patients with LVAD who were admitted to our acute rehabilitation center (ARC) between 1/1/2012 and 08/31/2013, regardless of admission diagnosis. Demographics, medical comorbidities, reason for LVAD, length of stay (LOS), and FIM scores (Functional Independence score - uniform system of measurement for disability based on the International Classification of Impairment, Disabilities and Handicaps) on admission and discharge were recorded. Change in FIM scores and rehabilitation efficiency (change in FIM score/LOS) were analyzed. We performed an IRB-approved, retrospective review of all patients with LVAD who were admitted to our acute rehabilitation center (ARC) between 1/1/2012 and 08/31/2013, regardless of admission diagnosis. Demographics, medical comorbidities, reason for LVAD, length of stay (LOS), and FIM scores (Functional Independence score - uniform system of measurement for disability based on the International Classification of Impairment, Disabilities and Handicaps) on admission and discharge were recorded. Change in FIM scores and rehabilitation efficiency (change in FIM score/LOS) were analyzed. ResultsWe identified 30 males and 2 females with mean age (±SD) of 64±10.5 years. Half were implanted as bridge to transplant and 24 were admitted after initial implant. 2 patients were excluded as outliers as 1 was transferred back in less than 24 hrs, and another stayed for 40 days due to disposition issues. 6 out of 32 patients had to be readmitted to acute hospital due to complications (2 had firing of ICD, 2 had hypotension, 1 transferred due to concern for hemolysis and 1 transferred due to concern for clot), 2 were discharged to skilled nursing facility due to social situation and 24 were discharged home safely. Mean (±SD) LOS was 9.93(+/-4.84) days. The mean (±SD) FIM gain was statistically significant at 25.53 (+/- 10.36) (p <0.0001), and was comparable to regional (23.6) and national (27.8) mean for patients admitted to ARCs with any cardiac diagnosis. The mean (±SD) FIM efficiency (FIM gain/ARC LOS) was 2.90 (+/- 1.28) in comparison with the regional mean of 2.56 and national mean of 2.86. We identified 30 males and 2 females with mean age (±SD) of 64±10.5 years. Half were implanted as bridge to transplant and 24 were admitted after initial implant. 2 patients were excluded as outliers as 1 was transferred back in less than 24 hrs, and another stayed for 40 days due to disposition issues. 6 out of 32 patients had to be readmitted to acute hospital due to complications (2 had firing of ICD, 2 had hypotension, 1 transferred due to concern for hemolysis and 1 transferred due to concern for clot), 2 were discharged to skilled nursing facility due to social situation and 24 were discharged home safely. Mean (±SD) LOS was 9.93(+/-4.84) days. The mean (±SD) FIM gain was statistically significant at 25.53 (+/- 10.36) (p <0.0001), and was comparable to regional (23.6) and national (27.8) mean for patients admitted to ARCs with any cardiac diagnosis. The mean (±SD) FIM efficiency (FIM gain/ARC LOS) was 2.90 (+/- 1.28) in comparison with the regional mean of 2.56 and national mean of 2.86. ConclusionRehabilitation following LVAD placement is critical to optimal outcomes. Despite a readmission rate of 19%, the majority went home with statistically significant improvement in their functional capacity, compared to national and regional standards for cardiac diseases. Acute rehabilitation should be considered in post LVAD patients before transitioning to home. Rehabilitation following LVAD placement is critical to optimal outcomes. Despite a readmission rate of 19%, the majority went home with statistically significant improvement in their functional capacity, compared to national and regional standards for cardiac diseases. Acute rehabilitation should be considered in post LVAD patients before transitioning to home.