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Implementation of an intensified outpatient follow-up protocol improves outcomes in patients with ventricular assist devices

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Abstract

Background

Ventricular assist devices (VAD) are increasingly used as long-term treatment for advanced heart failure. However, survival after VAD implantation is still unsatisfactory, and no specific outpatient follow-up algorithms have been formally established. Here, we evaluate the effect of an intensified follow-up protocol (IFUP) on survival rates and VAD-associated complications.

Methods and results

This is a retrospective study of 57 patients who received a VAD at our center between February 2013 and December 2017. Inclusion criteria were discharge home after VAD implantation and follow-up in our VAD outpatient clinic. Patients implanted after October 2015 (n = 30) were monitored according to IFUP. This protocol embodied formalized, multi-disciplinary clinical visits every 4–8 weeks including a cardiologist, a cardiothoracic surgeon and a VAD-coordinator and was characterized by optimized anticoagulation and wound management as well as guideline-directed medical therapy. One-year survival in the IFUP patients was 97%, compared to 74% in the pre-IFUP era (p = 0.01). Implementation of IFUP was associated with a 90% risk-reduction for 1-year mortality (relative risk 0.099; p = 0.048). The rate of complications, e.g., device thrombosis and major bleeding, was significantly reduced, resulting in superior event-free survival in the IFUP group (p = 0.003). Furthermore, by implementation of IFUP, a more stable anticoagulation adjustment was achieved as well as an improved adherence to guideline-directed medical therapy.

Conclusion

Implementation of an IFUP for VAD patients is associated with a significant decrease in 1-year all-cause mortality. This emphasizes the need for more vigilance in the management of VAD patients by a dedicated multi-disciplinary team.

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Acknowledgements

We thank Tanja Proctor, M.Sc. (Institute for Medical Biometry and Medical informatics, University of Heidelberg, Heidelberg, Germany) for statistical advice and review.

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Authors and Affiliations

  1. Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    Sonja Hamed, Florian Mueller, Philipp Ehlermann, Davina Hittmann, Hugo A. Katus, Philip W. Raake & Michael M. Kreusser

  2. Department of Cardiac Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Bastian Schmack, Florian Mueller, Arjang Ruhparwar & Hugo A. Katus

  3. DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany

    Arjang Ruhparwar, Philip W. Raake & Michael M. Kreusser

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  1. Sonja Hamed
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Correspondence to Michael M. Kreusser.

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Conflict of interest

BS and AR received travel grants (for international conferences) and consultancy fees from Berlin Heart. PWR received speaker honoraria from Abbott (Thoratec). MMK received research grants from Abbott (Thoratec) and travel grants (for international conferences) from Medtronic (HeartWare). The other authors report no conflict of interest regarding the content herein.

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Hamed, S., Schmack, B., Mueller, F. et al. Implementation of an intensified outpatient follow-up protocol improves outcomes in patients with ventricular assist devices. Clin Res Cardiol 108, 1197–1207 (2019). https://doi.org/10.1007/s00392-019-01451-9

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