Structured Rehabilitation Program in LVAD Patients Leads to Shortened Lengths of Stay

Abstract

Purpose Candidates for LVAD implantation tend to have poor functional status due to their heart failure. A structured rehabilitation program is essential for these patients to regain functional mobility post-LVAD implant. Methods and Materials Our physical therapy program is personalized and has 4 phases which address functional limitations. Phase-I: patients who are in the acute phase with multiple medical problems and/or unable to stand. Phase-II: patients in the subacute phase; continue to have multiple medical problems but who are stable and ready to start pre-gait activities. Phase-III: patients with resolving medical problems who are able to start gait re-education activities. Phase-IV: stable and without significant medical problems. The physical therapy evaluation includes the assessment of mental status, vital signs, skin integrity, strength, range of motion, sensation, coordination, balance, gait, endurance, and the prior level of function. The program is initiated within 48 hours of implant. The physical therapy occurs once daily for 7 days/week and the duration of a treatment session is 15 minutes to 1 hour. Results 91 patients went through our rehabilitation program starting Jan 1, 2010 – Dec 31, 2011. Demographics: Male 75% vs Female 25%; patients were mostly INTERMACS 1-2 pre-VAD. Average post-implant ICU days = 10.4; Post-implant total Length of Stay (LOS) days (average) = 20.1. Compared to 2008-2009 which was pre-implementation of our structured PT program, post-implant LOS was 37.5 days on average. During our current study period, discharge to home was 41% and discharge to temporary acute care facility was 59%. Conclusions LVAD patients are able to recover more effectively from their severe heart failure status with the aid of an appropriate mobility program. Our aggressive stepwise PT program provides clinical benefit for post-LVAD recovery as demonstrated by our low LOS following LVAD implantation.