Ventricular Assist Device Coordinators Research Articles

The Role of Ventricular Assist Device Coordinator Nurse in Saudi Arabia

Background: The Ventricular Assist Device (VAD) Coordinator Nurse plays a vital role in managing patients with end-stage heart failure requiring mechanical circulatory support. However, limited research exists on the specific responsibilities and contributions of VAD coordinators, particularly in Saudi Arabia. Understanding their roles and impact on patient care and organizational outcomes is crucial for healthcare improvement. Objective: This study examined the role of VAD Coordinator Nurse in Saudi Arabia by describing the role characteristics, including demographic information, qualifications, compensation, job preparation, work setting and responsibilities, scope of practice, contributions to patient care, and organizational outcomes. Methods: A descriptive study was conducted to explore the roles of VAD Coordinator Nurses in Saudi Arabia. A survey instrument developed by Casida (2011) was used to collect data from VAD coordinators working in Saudi Arabian centers offering VAD services. Convenience sampling was employed, and the survey was distributed electronically through the hospital's email system. Descriptive statistics, including percentages and frequencies, were calculated using the Statistical Package for the Social Sciences (SPSS). Results: The study involved VAD coordinators with an average age of 36.47 years, predominantly male (60%), and Arab (80%). Most participants held a bachelor’s degree (60%) and had previous experience as staff nurses. Findings revealed that VAD Coordinator Nurses have diverse responsibilities, including patient monitoring, VAD performance evaluation, medical emergency management, and coordination of ancillary tasks. Conclusions: This study highlights the dynamic and multifaceted roles of VAD Coordinator Nurses in Saudi Arabia. They play a crucial role in bridging the technical and clinical aspects of VADs, ensuring optimal patient care, and contributing to positive organizational outcomes. Understanding their demographics, qualifications, responsibilities, and contributions is essential for healthcare policies and job preparation enhancements. Future research should address challenges faced by VAD coordinators and support their professional growth in delivering high-quality care to patients with end-stage heart failure.

(1094) Why We Stay: A National Study of Ventricular Assist Device Coordinators in the Role for 10+ Years

(1094) Why We Stay: A National Study of Ventricular Assist Device Coordinators in the Role for 10+ Years

Ventricular Assist Device Self-care Education at Tertiary Care Medical Centers.

Ventricular assist device (VAD) implantation requires patients and caregivers to attain self-care knowledge and skills before discharge from implant hospitalization. Inability to perform these skills can have devastating outcomes (i.e., death from pump malfunction, driveline site infections, and stroke). No standard-of-care guiding VAD self-care education exists. We sought to describe how select tertiary care VAD implant centers across the United States currently educate VAD patients and their caregivers. Using a multiple case studies design with a purposive sampling strategy, we conducted semistructured interviews of VAD coordinators responsible for VAD education at 18 centers. From audio recording of interviews, we used rapid qualitative analysis to organize and analyze the data. All centers spent significant time and effort educating patients and caregivers on VAD self-care. Although centers teach similar content, the rigor of assessments and follow-up education differed vastly. Only 3/18 (17%) centers performed competency-based assessments with a skills checklist and minimum passing standard assessing readiness to perform VAD self-care independently. Twelve of 18 (67%) centers provided formal follow-up education to address skills decay, yet wide variation existed in timing and content of education. Due to the diversity among centers regarding VAD self-care education, more prescriptive practice guidelines are needed.

Psychological Journey of a Patient With a Ventricular Assist Device: A VAD Coordinator's Perspective.

A thorough psychosocial assessment is needed during the evaluation of candidacy for ventricular assist device placement to identify potential barriers that would limit success with the device. Ventricular assist device coordinators are generally involved in the psychosocial assessment of the patient, allowing them to provide a more holistic approach to ventricular assist device candidacy during discussions at multidisciplinary meetings. There is a gap in the literature describing the psychological journey of patients after ventricular assist device implantation and the challenges ventricular assist device coordinators face when caring for this complex population. The psychological journey of 3 patients with a ventricular assist device was explored to determine if common themes exist and to describe the experiences faced by the ventricular assist device coordinators with each patient. Three patient case scenarios are described, as are the interactions with the patients' ventricular assist device coordinator team members. All 3 case scenarios demonstrate similarities of younger ages, the need of family and social support, and ventricular assist device coordinators who went beyond the call of duty to assist in the successful heart transplantation for 2 cases and the successful decommission of the ventricular assist device in another case. The psychosocial needs of patients with a ventricular assist device and ventricular assist device coordinators require ongoing assessment because of the many physical and emotional challenges that arise during the time a patient has an implanted ventricular assist device.

Current International State of Remote Monitoring Ventricular Assist Device Patients

As ventricular assist device (VAD) survival rates improve, focus has shifted to decreasing adverse events. Remote monitoring (RM) is a tool to optimize care and VAD coordinators are often responsible for implementing RM. Currently, there is limited research on the clinical benefits of RM in VAD patients. The aim of this study was to examine how VAD coordinators utilize RM, the impact on their workflow, and their perceptions of this technology. An online survey was distributed via the Mechanical Circulatory Support Collaboration yahoo group and International Consortium of Circulatory Assist Clinicians email from July to August 2019. The survey included questions regarding- center demographics, workflow, feature utilization, and clinical impact. Basic statistical analysis was performed, and open response questions were analyzed for recurrent themes. A total of 34 surveys were received representing 28 centers in 4 countries. Regarding which RM platforms are utilized- 74.3% use Acelis Connected Health, 22.9% ActiCare Health, and 20% "other." An average of 12.5 hours per week (range 2-168) was dedicated to RM. The most followed data was: International Normalized Ratio (INR) (82.9%), weight (77.1%), VAD parameters (74.3%) and blood pressure (62.9%). For 82% the RM platform does not interface with the patient chart, and 60% do not bill for RM services. Patients are instructed to upload photos of their driveline exit site by 62.9% of respondents. A majority do not use RM to track VAD equipment (64.7%), ask questions to their patients (65.7%), or for video conferencing (94.3%). Three themes emerged: INR monitoring was the most useful (33%), coordinators found parameter trends beneficial (33%) and RM holds patients more accountable (23.8%). The potential improvements identified were: 40.9% found the platforms to not be user friendly, and 18.1% expressed frustration that not all patients were eligible due to insurance benefits. In regards to clinical outcomes, 82.8% do not have quality measures with RM. This survey shows RM is now part of the VAD coordinator daily workflow. Most use 3rd party vendors and have patients transmit daily. There is an increase in coordinator work in exchange for a perceived improvement in patient care. INR monitoring was the most followed parameter. An improvement in platform interfaces may increase utilization of this emerging tool.

Preparing for Discharge in Pediatric Ventricular Assist Device Supported Patients

While the use of durable ventricular assist device (VAD) support with potential for discharge in pediatric patients has increased over time, there is limited knowledge of individual centers' approach to preparation and education for patients and families around discharge. The Advanced Cardiac Therapies Improving Outcomes Network (ACTION) was surveyed in September 2018 to determine current discharge practices in preparation for a quality improvement project. Surveys were sent to 28 sites, with 22 sites responding (response rate 78.5%). The majority of programs (86.4%, 18/22) reported having a standardized discharge protocol. Discharge teaching was performed in a majority of centers by a VAD coordinator (95.5%). Frequently utilized practices in preparation for discharge included field trips with and without medical chaperones, assessment of home environment (without an actual visit), rooming-in process, establishment of an EMS plan, and education about using a shower bag. The three main topics that patient and families received education on was: dressing change teaching, VAD equipment teaching and emergency planning. In terms of community outreach, programs offered education to EMS (72.7%), school staff (63.6%) and local fire stations (50%). In addition, 50% notified the local utility company in case of an electricity outage. The majority of programs caring for pediatric patients on durable VADs have a standardized approach to discharge with extensive education of patients, families, and community providers. As most programs discharge a small number of patients, a collaborative effort can allow for the development of shared educational materials that best address the needs of patients and their families.

Infrastructural needs and expected benefits of telemonitoring in left ventricular assist device therapy: Results of a qualitative study using expert interviews and focus group discussions with patients.

Heart failure is one of the most expensive chronic diseases, as it leads to considerable expenses due to increasing hospitalisation rates. In addition to the implications of the demographic transition and the lack of available organs for transplantation, a major challenge in this context is that conservative treatment options are limited. This has led to the research and development of mechanical circulatory assist systems. Telemonitoring is anticipated to be an effective tool in outpatient management, which may be a key to improved outcomes of left ventricular assist devices therapy. In patients with chronic cardiac diseases, telemedicine is already used and has been shown to reduce premature mortality. This study aims to provide insights into the left ventricular assist device-specific requirements for telemonitoring and infrastructural translation from caregivers' and patients' points of view. A qualitative investigation based on guided interview and focus group techniques was conducted at two German heart centres. The study included 15 patients and 7 caregivers (4 cardiac surgeons, 3 ventricular assist device coordinators). Qualitative content analysis was used for data analysis. The categories for analysis were (1) benefits for patients, (2) benefits for hospitals and the healthcare system, (3) acceptance and causative factors and (4) infrastructural implementation. Patients and experts expect the following benefits for telemonitored patients: added safety, early detection of complications, rapid intervention in case of emergency, regular inspection of pump parameters, fewer outpatient clinic visits and the ability to provide more informed feedback and instructions to the family members who take care of the patient. However, the expected acceptance of telemonitoring in left ventricular assist device therapy differed among the interviewed groups. Alongside the aforementioned expected benefits, patients and clinical experts criticised the reduced self-determination for the patient, probable large amounts of time/effort required of the patient and caregiver and data protection/integrity issues (data misuse, device manipulation and mistransfer). Interviewees expected easy handling, proper education and safe data transmission to be necessary factors leading to acceptance. Complication rate reduction, fewer hospitalisations and cost reductions were benefits recorded for the healthcare system and clinics. Clinical experts preferred a telemonitoring centre run by ventricular assist device coordinators. Although positive expectations are associated with the use of telemonitoring in left ventricular assist device therapy, further action is needed. For example, software and infrastructure developers will need to address issues such as variations among patients and may need to find a balance between designing individualised solutions for compliant patients and a safe and easy-to-handle set-up. In addition, proper elucidation of users will contribute to the successful implementation of a left ventricular assist device telemonitoring programme among patients and caregivers.

Patient, Caregiver, and Clinician Perceptions of Ventricular Assist Device Self-care Education Inform the Development of a Simulation-based Mastery Learning Curriculum.

Patients who undergo ventricular assist device (VAD) implantation and their caregivers must rapidly learn a significant amount of self-care skills and knowledge. The aim of this study was to explore patient, caregiver, VAD coordinator, and physician perspectives and perceptions of existing VAD self-care training to inform development of a simulation-based mastery learning (SBML) curriculum to teach patients and caregivers VAD self-care skills and knowledge. We conducted semistructured, in-person interviews with patients with a VAD, their caregivers, VAD coordinators, and physicians (cardiac surgeons, an infectious disease physician, and advanced heart failure cardiologists). We used a 2-cycle team-based iterative inductive approach to coding and analysis. We interviewed 16 patients, 12 caregivers, 7 VAD coordinators, and 11 physicians. Seven major themes were derived from the interviews including (1) identification of critical curricular content, (2) need for standardization and assessment, (3) training modalities, (4) benefits of repetition, (5) piercing it all together, (6) need for refresher training, and (7) provision of training before implant. Findings from this study suggest that SBML is a natural fit for the high-risk tasks needed to save VAD self-care. The 7 unique training-related themes derived from the qualitative data informed the design and development of a VAD SBML self-care curriculum.

Caring for Patients With Ventricular Assist Devices: A Mini-Review of the Literature

Heart transplantation, one of the treatment options for end-stage heart failure, is still regarded as the gold standard treatment to improve quality and length of life. However, the rapid increase in the number of patients waiting for heart transplantation and the inadequate number of donors makes heart transplantation a less feasible option and increases the need for ventricular assist devices as an alternative. The success of ventricular assist device implantation requires the collaboration of a multidisciplinary team consisting of cardiac surgeons, nurses, ventricular assist device coordinators, cardiologist, cardiac anesthesia specialists, perfusionists, and physiotherapists. Nurses working in different fields such as intensive care units, operating rooms, outpatient clinics, and ventricular assist device coordination units have important responsibilities in multidisciplinary teams. In this study, national and international studies on the responsibilities of nurses for the management and care of ventricular assist devices were reviewed. Nurses undertake many tasks, especially in the postoperative care of patients and in preparing them for discharge. Important responsibilities of nurses in the care of patients with ventricular assist devices include monitoring complications, managing equipment and emergency situations, establishing dressing change protocols, organizing daily life activities, determining rehabilitation needs, ensuring use of medicines, and providing comprehensive discharge education. Organizational and communication skills of nurses working with multidisciplinary teams are very important for the success of the ventricular assist device implantation process.

The Intersection of Quality and Clinical Care: Approach to Improve Ventricular Assist Device Patient Care

Background Improving outcomes in the Ventricular Assist Device (VAD) patient population is an on-going challenge. Incorporating comprehensive quality into a VAD program ensures not only meeting accreditation standards, but helps improve patient care. We used performance measure data to identify deficiencies and garner stakeholder buy-in with the intended goal of improving care. Methods The quality specialist worked closely with the VAD team to identify the performance measures for the program as well as establish benchmarks using evidenced based best practices. Each performance measure was distinctly tied to a data point that would subsequently be abstracted from the chart for each patient. The quality specialist and VAD Coordinator then incorporated the quality measures and performance goals into a QAPI Plan and encouraged stakeholders to review and provide feedback. By engaging stakeholders to review and revise, we promoted buy-in to the QAPI elements of the VAD program. Performance measures were tracked monthly. Variance on the scorecard was presented to the VAD multidisciplinary team as well as Hospital Quality Council. If variance occurred, performance improvement activities were developed. Results A unique color-coded QAPI scorecard was created in which different colors represented different levels of compliance. The metrics were tracked using the Scorecard and presented at the monthly meetings. At baseline, driveline dressing change compliance was 63%. After implementation of our improvement measures, compliance increased to 81%. Similarly, performance of Daily Weights increased from 36% to 96%. Documentation of Nursing VAD Education increased from 57% to 97% and documentation of Pain Assessment increased from 64% to 97%. We maintained a zero percent rate of driveline infection. Conclusion Creating stakeholder awareness of gaps in performance increased commitment to performance improvement plans. Use of a unique color coded QAPI scorecard can be useful in improving quality metrics and subsequently patient care. This approach can be utilized beyond the VAD population to improve quality among all heart failure and transplant patients.

The Effect of Judge Selection on Standard Setting Using the Mastery Angoff Method during Development of a Ventricular Assist Device Self-Care Curriculum

BackgroundPatients and caregivers need to perform ventricular assist device (VAD) self-care safely to help prevent complications (e.g., infection). We developed a VAD self-care simulation-based mastery learning (SBML) curriculum. We determined optimal minimum passing scores (MPSs) and evaluated effects of judge selection. MethodsA multidisciplinary team created a VAD self-care SBML curriculum including simulated skills and knowledge examinations. Patients, caregivers, VAD coordinators, and physicians were expert judges who determined MPSs using the Mastery Angoff method. ResultsMPSs for the skills and knowledge examinations were high (range = 94%-99% and 97% correct, respectively). Judges closely agreed on MPSs. ConclusionsStakeholders set stringent MPSs for high-stakes VAD self-care.

Common clinical dilemmas in left ventricular assist device therapy: A glimpse into current trends

Background
 Left ventricular assist device (LVAD) therapy has been thrust into the forefront of surgical treatment for advanced heart failure (HF). Despite advancements in survival and quality of life with these devices, the multi-disciplinary care for these patients remains far from standardized across institutions.
 Methods 
 A survey of current practices in LVAD was carried out at the St. Jude Medical User’s meeting representing a variety of caregivers including cardiac surgeons, HF cardiologists, non-HF cardiologists, advanced practice providers and ventricular assist device coordinators, with representation from several continents. Utilizing an audience response system, eleven questions were asked related to the demographics of the audience, left ventricular assist device patient selection and patient management.
 Results
 A total of 120 audience members representing both transplant and LVAD centers, destination therapy only LVAD centers and non-implanting, shared care centers across a multitude of disciplines responded to the survey. Questions comprised of patient selection (body mass index, pre-existing renal failure, care giver presence and abstinence from substance abuse) and patient management (anticoagulation regimens, first line therapy for hemolysis, implantable cardioverter-defibrillator usage and route of preferred dialysis) issues.
 Conclusions
 LVAD technology will continue to change and improve with the next generation of pumps on the horizon. Progress cannot be made without pausing to understand the current state of technology, practice patterns and patient determinants of success. This survey underscores the lack of consensus regarding best practice principles and the need for an increased focus on care management for LVAD patients with collaborative, multi-institutional studies.

El rol de la enfermera coordinadora de asistencia ventricular en España: el futuro ya ha llegado

Ventricular assist devices have revolutionized the treatment of patients with advanced heart failure refractory to medical therapy, as a bridge to transplantation, and more recently also as destination therapy. Due to the increase in the number of patients treated with these devices, and the specific and differentiated management required, it has become clear the need to create a new job: a registered nurse or ventricular assist device coordinator (trained in hospitals specialized in mechanical circulatory support), who is responsible for the management of these patients. We believe that this nurse is necessary as it would improve clinical outcomes (reduction of complications), and would be the kingpin in the care of these patients to increase their quality of life, reducing the number of readmissions, and above all, increasing patient and family satisfaction.

Concomitant surgery during ventricular assist device implantation.

Today, ventricular assist device (VAD) implantation is an established treatment for end-stage heart failure. However, there are various cardiovascular pathologies that require concomitant treatments during surgical VAD implantation, which may render the procedure difficult or compromise VAD function. Furthermore, there are certain clinical situations that prohibit VAD implantation (1,2). Aortic valve regurgitation or the presence of a mechanical aortic valve prosthesis are relative contraindications for implantation of left ventricular assist devices (LVADs). In such cases, one option is to undertake concomitant aortic valve replacement with a biological prosthesis. In stable patients, simultaneous aortic valve replacement and LVAD implantation are not associated with a poorer outcome. However, in patients with cardiogenic shock, concomitant aortic valve replacement may impair outcomes, and therefore alternative techniques should be considered (3). In the case of significant aortic regurgitation causing a progressive increase in left ventricular diameter which cannot be compensated by increased pump output, two options are available. Firstly, a transplant candidate may be shifted to a high-urgency status on the waiting list, and secondly, conventional aortic valve replacement can be considered for patients who require permanent VAD support. New catheter-based technologies, such as transarterial aortic valve implantation or closure of aortic valves by devices similar to those used for septal defect closure, should first be evaluated in an experimental setting. Mitral stenosis must be corrected during LVAD implantation, as the presence of a mitral valve prosthesis (mechanical or biological) is not a contraindication for LVAD placement. The presence of pulmonary artery thrombi in patients scheduled for LVAD implantation significantly increases the risk of postoperative right ventricular failure (RVF). Right ventricular assist device (RVAD) support may be useful in isolated RVF after embolectomy and RVF following LVAD insertion (4). Patients with active systemic infections should not be considered for LVAD support, as infection is a leading cause of morbidity and mortality. Implantation should be delayed for patients with localized infections that can be effectively treated, if clinically feasible. Type A acute aortic dissection (AAD) is a life-threatening emergency that carries a high mortality rate without surgical treatment. Surgical outcomes of AAD have been improving with increasing experience and advances in diagnosis, surgical techniques and perioperative management. However, there continues to be individuals who require mechanical assistance immediately after life-saving surgery as a result of terminal heart failure following AAD. VAD or total artificial heart (TAH) therapy are feasible options for individuals who suffer from AAD and have undergone surgical treatment. Assessment of patients’ clinical status (severity of shock and coagulopathy) and right ventricular function is paramount in the selection of an appropriate therapy (TAH vs. biventricular assist device vs. LVAD). VAD implantation may also be part of the treatment for end-stage heart failure in adults with complex congenital heart defects (CHDs). These patients are managed by a collaborative team of specialists [pediatric surgeon, mechanical circulatory support (MCS) surgeon, MCS cardiologist, and VAD coordinator], who have a clear understanding of cardiovascular anatomy, pathophysiology of specific heart defects and additional risks incurred with surgery. The team must also be able to effectively evaluate the risk of biventricular versus univentricular failure, the suitability of device types and configurations for different forms of CHD and individual anticoagulation management (5). In patients with previous or repeated sternotomies, we prefer the left lateral thoracotomy approach when the goal is to achieve permanent assist device support. Special consideration must be given to factors such as old age, severity of cardiogenic shock, and multi-organ failure, where additional procedures may likely increase the risks of LVAD implantation. Video Concomitant surgery during ventricular assist device implantation.

Programming Considerations for Including Patients With Heart Failure Into Phase 2 Cardiac Rehabilitation

Programming Considerations for Including Patients With Heart Failure Into Phase 2 Cardiac Rehabilitation

Surgical heart failure treatment program - the experience of Kazakhstan

In Kazakhstan, geographical and cultural reasons do not favor the development of heart transplant activity. Thus, a surgical program for treatment of advanced, refractory heart failure was implemented, focusing the efforts on ventricular assist device (VAD) therapy. The program, supported and funded by the national healthcare system, is based on a single, highly specialized surgical Center for the operation, and on a regional infrastructure for outpatient follow-up. Regional VAD coordinators are educated by the National Center. They are in charge of regular patient check, anticoagulant and antiplatelet treatment prescription, and continuing patients' and caregivers' education, mainly regarding driveline exit site dressing and driveline stabilization. From November 2011 to November 2013, 95 patients received 100 devices, mainly for left ventricular support (LVAD): HeartMate II, n=70, HeartWare, n=25. Mean age was 49.5 years, and 87.37% of the patients were males. Most patients had INTERMACS profile 4 (55%), followed by 3 and 2 (17% each). Symptomatic and functional improvement are testified by changes from baseline to month 3 of NYHA functional class (from III-IV to I-II), results of the 6-min walk test (from 152 to 440 m), and NT-proBNP levels (from 6997 to 1126 pg/ml). Overall 1-year survival was 69%, with a trend for outcome improvement over time and a relationship with preoperative INTERMACS profile (1-year survival of 60% in patients with INTERMACS profile 1-2 vs 75% in those with INTERMACS profile 3-4). In summary, where and when a heart transplant program cannot be implemented, LVAD represents a realistic therapeutic alternative. The key points for a successful VAD program are a dedicated, highly specialized multidisciplinary team at the Cardiac Surgery Center, an infrastructure throughout the country for coordinated outpatient follow-up, adequate reimbursement for this activity, and support by the healthcare system.

How self-care education in ventricular assist device programs is organized and provided: A national study

ObjectiveTo describe the care delivery structure and elements used for patient self-care education in ventricular assist device (VAD) programs. BackgroundUse of VADs as destination therapy and to sustain organ function until cardiac transplantation has increased 517% since 2007. Elements of VAD-specific self-care education have not been described. MethodsA 26-item survey measuring VAD self-care education resource use, organizational, employment, behavioral and labor variables was sent to VAD coordinators at all US VAD centers (N = 111) in 2011. Two subsequent mailings yielded a 63% (n = 71) return rate. Analysis included descriptive statistics and cluster analysis. ResultsElement use varied across programs. Reliance on single educational and evaluation methods, and lack of return demonstration were noted. VAD coordinators reported extensive caregiver, hospital provider, and community educational responsibilities in addition to patient self-care education. ConclusionsVAD self-care education programs varied by hospital. Future research is needed to determine if specific care delivery structures or elements used in self-care education improve VAD patient outcomes.

Health-Related Quality of Life among Patients with Mechanical Circulatory Assistance: Clinician Perspectives

Purpose There is a lack of validated outcome measures that assess health-related quality of life (HRQOL) among patients with mechanical circulatory support (MCS). The purpose of this qualitative study was to obtain health care clinicians’ perspectives on factors that influence HRQOL, both positively and negatively, among advanced heart failure patients with MCS. Methods and Materials We conducted semi-structured qualitative interviews with 15 clinicians who provide care to MCS patients (including 3 cardiac surgeons, 3 cardiologists, 2 palliative care physicians, 3 ventricular assist device coordinators, 2 social workers, and 2 psychologists). Interviews lasted 30-60 minutes, were audio-recorded, and transcribed verbatim. Data were analyzed using a 2-phase strategy of descriptive and thematic coding. Results Clinicians described a wide range of issues that impact on HRQOL of patients with MCS. Clinicians identified positive outcomes: improved physical function, decreased symptom burden, and increased life expectancy, often described as “the gift of time.” Importantly, clinicians identified negative outcomes related to the emotional impact of MCS: loss of independence and autonomy, uncertainty about the future, and concerns about being a burden to loved ones. Disturbed role performance and anxiety about device management were identified as problems in the early post-implant phase but tended to resolve over time. Finally, clinicians indicated that a small subset of patients, typically those with device-related complications, expressed regret over their decision to receive a device. Conclusions HRQOL among patients with MCS is a multi-dimensional construct that includes symptom burden, physical function and role performance, and emotional and relational impact. Clinicians indicated that MCS can have both a positive and negative impact on HRQOL. These findings indicate the necessity of developing a measure of HRQOL for patients with MCS. This will be done by triangulating clinician interviews with patient and caregiver interviews.

A two-round Delphi study examining consensus of recommended clinical practices for patients with ventricular assist devices as destination therapy

To identify the current clinical practices of Medicare-certified facilities offering ventricular assist devices as destination therapy and to attain a consensus of recommended clinical practices across the United States for the management of adults with ventricular assist devices as destination therapy. Sixty ventricular assist device coordinators from Medicare-certified centers were invited to participate in an online, 2-round Delphi survey. The surveys asked whether recommended practices are current practices and whether respondents always/agreed or never/disagreed with performing the recommended practice guidelines. Consensus was defined as 75% agreement. The clinical areas of focus were patient selection, preoperative preparation, postoperative care, infection control, nutrition, and patient discharge preparation. Practices were extracted from the advanced practice guidelines for HeartMate destination therapy and the International Society for Heart and Lung Transplantation's 2006 guidelines for the care of heart transplant candidates. Representing 21 states across the country, the first-round survey had a response rate of 57% (n = 34). The second-round survey had a response rate of 74% (n = 17), representing 28% of the 60 centers. Consensus was obtained for 122 practices. The dimension of patient selection-diagnostic tests and screening had the highest level of consensus (16%, n = 20), and the dimension of postoperative care-intermediate/intensive care unit dimension had the lowest level of consensus (3.3%, n = 4). Survey results identify a consensus of practices for the specific group of ventricular assist device coordinators who responded, but that consensus cannot be generalized to all ventricular assist device facilities. These results can, however, provide a foundation for further research leading to the development of standard-of-care practices for patients with ventricular assist devices as destination therapy.

A Two-Round Delphi Study Examining Consensus of Recommended Clinical Practices for Patients with Ventricular Assist Devices as Destination Therapy

To identify the current clinical practices of Medicare-certified facilities offering ventricular assist devices as destination therapy and to attain a consensus of recommended clinical practices across the United States for the management of adults with ventricular assist devices as destination therapy. Sixty ventricular assist device coordinators from Medicare-certified centers were invited to participate in an online, 2-round Delphi survey. The surveys asked whether recommended practices are current practices and whether respondents always/agreed or never/disagreed with performing the recommended practice guidelines. Consensus was defined as 75% agreement. The clinical areas of focus were patient selection, preoperative preparation, postoperative care, infection control, nutrition, and patient discharge preparation. Practices were extracted from the advanced practice guidelines for HeartMate destination therapy and the International Society for Heart and Lung Transplantation's 2006 guidelines for the care of heart transplant candidates. Representing 21 states across the country, the first-round survey had a response rate of 57% (n = 34). The second-round survey had a response rate of 74% (n = 17), representing 28% of the 60 centers. Consensus was obtained for 122 practices. The dimension of patient selection-diagnostic tests and screening had the highest level of consensus (16%, n = 20), and the dimension of postoperative care-intermediate/intensive care unit dimension had the lowest level of consensus (3.3%, n = 4). Survey results identify a consensus of practices for the specific group of ventricular assist device coordinators who responded, but that consensus cannot be generalized to all ventricular assist device facilities. These results can, however, provide a foundation for further research leading to the development of standard-of-care practices for patients with ventricular assist devices as destination therapy.