Effects of Patient Distance from LVAD Implant Center on Outcomes and Quality of Life

Abstract

Purpose Left Ventricular Assist Devices (LVADs) are a leading treatment for advanced heart failure. However, it is primarily major medical centers that have the resources to support an LVAD program. Many patients live far from an implant center, which makes it imperative that LVAD programs can provide quality care and support patients at a distance. The purpose of this project is to assess if distance to an implant center has an effect on patient outcomes and quality of life. We hypothesized that due to decreased accessibility to the hospital, increased distance to LVAD center would have an adverse effect on outcome and quality of life. Methods We performed a retrospective analysis of LVAD patients implanted at our institution from January 2012 to September 2020. Patients’ residential distance to LVAD center, outcome (transplant, explant, or death) and quality of life data (from EuroQol EQ-5D and KCCQ questionnaires) were analyzed. Descriptive statistics and logistic regression modeling were performed using STATA/ SE 15.1. Results 228 patients were included in the study (82% male, mean age of 57). The median distance from the hospital was 44.2 miles, with a range of 0.7 - 2458.0 miles. Distance was not associated with INTERMACS score, age at implant, race, gender, discharge destination, number of rehospitalizations within the first-year post-implant, or outcome. Distance was not associated with confidence in heart failure management, stress from health issues, or enjoyment of life (measured by EuroQol EQ-5D and KCCQ). Additionally, change in QOL scores from pre-implant to 6 months post-implant were analyzed and no significant associations were found based on distance to LVAD center. The mean distance to implant center was much higher in patients who had a stroke, however this difference was not statistically significant (94.8 mi vs 211.6 mi, p = 0.082). Conclusion Patient distance from LVAD center was not associated with outcomes including stroke and readmission or quality of life in this study. This indicates that patients do not need to reside near their LVAD center to feel supported and confident in their ability to manage their LVAD and that regional programs can provide quality care at a distance. There is a signal that of an increased risk of stroke in patients who are farther away which needs further investigation.