Clinicians Call for Physical Activity Guidelines for Pre- and Post- LVAD Implantation

Abstract

Specific guidelines for physical activity (PA) have not been developed for individuals receiving left ventricular assist devices (LVAD). Therefore, the purpose of this study was to examine clinician PA recommendations pre- and post-LVAD and the utilization of cardiac rehabilitation (CR) services post-implantation. This exploratory, descriptive study was conducted via REDCap survey from April 2019 through October 2019. Clinicians provided implied consent by completing the survey, which was distributed through LVAD clinician list servs, in person at a targeted international conference, and through targeted emails sent to primary, secondary, and senior authors of manuscripts studying exercise or PA in LVAD recipients. Clinicians were asked demographic information about themselves and their implanting centers. Survey questions focused on pre- and post-LVAD implantation PA recommendations. Clinicians were also asked to discuss their thoughts on guidelines for post-implantation PA. Fifty-nine complete survey responses were recorded. Clinicians represented LVAD implanting centers from 10 countries including Israel, the United Kingdom, Germany, Italy, Canada, Spain, Australia, and 24 states in the U.S. Clinicians were 23/59 (38%) cardiologists or cardio-thoracic surgeons, 16/59 (27%) LVAD coordinators, 7/59 (12%) advance practice providers, and 8 identified as other. Clinicians reported their centers averaged 31 (SD 20.6) LVAD implantations a year. Although 93% (55/59) of clinicians reported they encourage PA in patients prior to LVAD only 22% percent (13/59) reported providing guidance about monitoring and controlling exertion during PA. Ninety percent of clinicians reported that they provided recommendations for type, frequency, intensity and duration of exercise post-LVAD. Most respondents (58/59) reported that patients are referred to CR post-LVAD; however, less than half of these clinicians reported a CR program tailored to LVAD patients. Nearly all clinicians (54/59) indicated a desire for practice guidelines for post-LVAD PA. Although clinicians agreed that PA is important in the pre- and post-LVAD implantation periods, there is little guidance or evidence to support best practices. Further research is needed to develop evidence-based guidelines to direct PA for patients pre- and post- LVAD implantation.