Successful implementation of a shared care program for patients with a left ventricular assist device

Purpose

The increasing use of left-ventricular assist devices (LVAD) for patients with end-stage heart failure puts a challenge on the implanting centers due to a high demand of this patient group. Furthermore, since LVAD care is offered by a limited number of hospitals, the majority of patients has to travel long distances to attend the mandatory frequent outpatient controls.

Shared care programs may help to relieve the implanting centers by enabling the continuum of LVAD care beyond implanting centers to non-implanting centers (1). It may result in better access to care, shorter travel distance and improved quality of life in individual patients.

The aim of this descriptive study was to evaluate the implementation of a LVAD shared care program at a cardiac teaching hospital in the Netherlands.

Methods

We retrospectively evaluated the preparation, implementation and use of the shared care program in terms of organization and patient outcomes in the period between 2021 and 2026. Organizational outcomes included team structure, communication, and care organization. Patient outcomes included mortality, quantified outpatient visits in the implanting center and travel distances, and were compared to standard care.

Results

In September 2021, a multidisciplinary shared care team was formed , comprising of cardiologists, HF nurse specialists, and LVAD technicians. Monthly trainings were organized at the partnering LVAD implanting center. Unified protocols were adopted locally, and a communication structure was implemented, including weekly multidisciplinary team meetings. In September 2022, the program started scheduling outpatient visits in an alternating basis, which gradually extended to include inpatient care to LVAD patients and 24/7 care availability. Patient enrollment in the shared care program was based on joint decision making with the patient.

Between 2022 and 2026, a total of 17 patients received follow-up treatment as part of a shared care program at our LVAD shared care-site; 15 (88.5%) male, mean age 52.6 (SD 19.7) years. The main strategy was bridge to candidacy (n=11, 64.7%), followed by destination therapy (n=6; 35.3%). During follow-up, the mortality rate was 35.3% comparable to standard LVAD care. On average per patient, three outpatient visits were planned at the shared care site meaning a reduction of 50% at the implanting center. The program resulted in a significant travel reduction of an average of 411 km per year per patient.

Conclusion

Establishing a shared care program for LVAD patients in a non-implanting cardiac teaching hospital is safe and feasible. It significantly reduces outpatient care visits to the implanting center as well as travel distance for patients, with associated improvement in access to care, decreased costs and improved patient satisfaction.