Abstract
Purpose Pre-implant counseling of LVAD patients stresses the importance of following established protocols of medical, social and therapeutic behaviors. Failure to comply with protocols may affect transplant candidacy (BTT) however, it is unknown whether non-compliance (NC) affects survival or provokes adverse events. Methods and Materials A retrospective review of compliance behavior was carried out in 111 patients (38 Destination Therapy and 73 BTT) who were discharged home (5/2005 to 2/2012). A minimum of six months of follow-up was necessary for inclusion. Compliance with the care contract for the LVAD program was documented as were the incidence of cerebrovascular accident(CVA), device infection(INF), device malfunction, gastrointestinal bleeding(GIB), and readmission. Results Fifty-one of 111 patients had a total of 490 events of NC. The freedom from NC was 47% at one year. The most common cause of NC was failure to have ordered laboratory studies drawn (54% of cases). Six of 51 NC patients accounted for more than half (328) of the episodes of non-compliance. Other reasons for NC included: not following the medical plan (26%), self-medication (7%), failure to communicate with the VAD team (7%), failure to abstain from drugs, alcohol, or smoking (3%), failure to follow diet or exercise (2%), and poor VAD care and education (1%). Actuarial freedom from CVA, INF, and GIB was not significantly different between compliant and NC patients. Two year actuarial freedom from device malfunction was significantly higher (83%) in compliant patients versus those who were NC (63%) (p Conclusions Although NC with established protocols creates challenges when caring for LVAD patients, 2 year adverse event profiles appear unaffected by NC with medical guidelines. Long-term device reliability is significantly less when the program of care is not strictly followed.
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