P46: Rationale and Design of a Patient Empowerment Pilot: Self-Administered 6MWT Improve to Outcomes and Timely Utilization of Ventricular Assist Devices

Abstract

Background: Ventricular assist devices (VAD) are life-saving therapy for appropriately selected end-stage heart failure patients. Although life-prolonging, VAD implantation may accompany considerable lifestyle changes, need for caregiver support, and risk of complications. Furthermore, early evaluation of VAD therapy is important to minimize the exacerbation of cardiac dysfunction. Therefore, shared decision-making through a timely evaluation for VAD therapy is imperative to minimize discrepancies between patient goals and clinical outcomes. The 6-minute walk test (6MWT) is a validated measure to predict morbidity and mortality in advanced heart failure patients, but it can be costly and time-consuming to perform routinely in the clinic. The Timed Walk App is a smartphone application that allows patients to perform a self-directed 6MWT, providing clinicians and patients with opportunities for shared decision-making and a larger database of objective clinical data for VAD evaluation. This study aims to address whether the usage of the Timed Walk App by heart failure patients can improve the clinical outcomes and timely utilization of VAD therapy. Methods: Patients referred to the University of Florida Heart Failure Clinic with an ejection fraction of less than 30% will be considered for study inclusion. Eligible patients will be educated on using the Timed Walk App to self-administer the 6MWT. Patients will be instructed to perform the 6MWT every 15 days and at least once a month. The demographic information, heart failure etiology, and biomarkers of illness severity will be obtained from the electronic medical record. For enrolled patients with VAD implantation, the following data will be collected: time between referral and LAD implantation, hospital length of stay, and incidence of adverse events post-VAD. Quality of life (QOL) assessments using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and EQ-5D will be performed at one-, three-, six-, and twelve-month intervals post-VAD. Data collected will be compared to a retrospective propensity-matched cohort in a weighted 3:1 fashion [Figure]. Results: In comparison to standard clinical assessments, we will analyze whether the use of the Timed Walk App improves: 1) likelihood of implantation 2) time from referral to VAD 3) implant length of stay 4) incidence of post-implant adverse events and 5) patient-reported QOL and perception of care. Conclusion: This study aims to explore whether the patient-directed monitoring of heart failure progression using the Timed Walk App promotes timely and appropriate utilization of VAD therapy. Findings are expected to inform future studies exploring the usage of smartphone applications to facilitate shared decision-making in advanced heart failure patients to improve the quality of life and clinical outcomes of VAD therapy.