Shared Care Site To A Destination Therapy (dt) Left Ventricular Assist Device (lvad) Implant Site; A Novel Strategy To Start A Dt Lvad Program

Abstract

Introduction Left ventricular assist devices have become the standard of care for end-stage heart failure patients over the last decade. Most centers start the DT LVAD program without assessment of the regional need, advanced heart failure clinic, and infrastructure needed to support a DT LVAD program. The shared care model has previously been described where a patient is implanted at a regional center and then returns for complete care at the local heart failure program with similar outcomes. We explore the benefits of a novel model where a center does shared care prior to becoming a DT LVAD center. Hypothesis Benefits of Shared care LVAD site prior to transitioning into a Destination Therapy (DT) LVAD implant site. Methods Deborah Heart and lung center (DHLC) started an advanced heart failure program in 2017. Initially, advanced heart failure patients were referred to regional Destination therapy centers with a shared care model. After the implant, patients received complete care at the shared care site (DHLC). This helped the shared care site identify gaps and establish LVAD complication management services such as GI, neurology, ID, palliative care, nutrition, social work, and case management. Shared care experience lead DHLC to become a certified DT LVAD site by DNV-GL. Results From 4-2017 to 4-2020, 20 patients were implanted as a shared care model. 64% were implanted as intermacs 3 and 36 % were implanted as intermacs 1-2. 80 % of Intermacs 3 patients were discharged home and 65% of Intermacs 1-2 patients were discharged home. Over a 3year period, a total of 65 hospitalizations occurred. There were 16 GI bleeds events in a total of 31% of patients, 23% of patients had CVA events with a total of 5 events, and 5% of patients had driveline infections with 1 event. The mortality rate was 27 % with 6 mortalities in this time period. Currently, 22 patients are being followed as shared care. In 2/2019, DHLC was approved as a DT LVAD site. From 4-2019 to 5-2020, 15 patients have been implanted at DHLC with LVADS. Approximately,100 % of Intermacs 3 patients were discharged to home, and 75% of Intermacs1-2 patients were discharged to home from our LVAD site. 23 patients were hospitalized with 0% CVA events, 20% GI bleed events, and approximately 3 % driveline infections with a mortality rate were 15%. Conclusions There are currently 183 LVAD Implant sites in the US approved by CMS. Despite securing CMS approval, a significant number of sites perform less than 10 LVAD implants per year. Low implant volume has shown to increase adverse outcomes. Our experience indicates that new programs who want to start a DT LVAD program should start with a shared care to DT LVAD model. This model will help establish the infrastructure needed to support the program as well as improving outcomes. Further studies are needed to explore this model.