LVAD Care for the Rural Population: A Single-Center Experience

Abstract

Objectives LVAD therapy is an established treatment for patients with advanced heart failure. However, the persistent risk of long-term complications including pump thrombosis, GI bleeds and infection, requires close follow-up and care of these patients. This attentive care can be complicated in patients living in rural communities, distant from the implanting LVAD center, and may therefore complicate the post-implant outcomes for these patients, compared to patients living in urban settings or in close proximity to an LVAD center. We therefore chose to compare the outcomes of patients living in rural vs urban settings after DT-LVAD implantation. Methods A retrospective review of all LVAD implants performed at our center was undertaken. Patients who died in the perioperative period were excluded. Midterm outcomes for patients living in rural Nebraska were compared to patients living in the two largest urban centers in the state. Results A total of 40 LVAD implants occurred in patients who were discharged alive after the implant procedure. Of those, 19 were performed in patients living in urban centers, within 30 miles of an LVAD center. Thirty-day readmissions were somewhat more frequent in patients in urban settings (16% vs 9%). However, 68% of patients living in a rural setting experienced at least 1 readmission in the first year after implant, while only 52% of patients in an urban setting experienced any readmission. In the first year, stroke rates were higher in the rural-residing patients (10% vs 5%) while rates of major bleeds (4.7% rural vs 5.2% urban) and driveline infection rates were similar. One patient in the rural group died within 1 year after discharge, while there were no deaths in the urban-residing patients within the 1st year. At 2 years the actual survival was 76% in the rural-residing patients and 89% in the urban-residing patients. Conclusions LVAD therapy can be safely instituted in patients residing in rural settings. Although geography may limit some access to care, mid-term outcomes after implantation are acceptable. Our data suggests a trend towards higher rates of strokes and bleeds in patients residing in rural settings. In addition, there is a suggestion that patients residing in an urban setting with LVADs may experience improved long-term survival.