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1. HFA of the ESC Position paper on the management of LVAD supported patients for the non LVAD specialist healthcare provider Part 1: Introduction and at the non‐hospital settings in the community

Author

Binyamin Ben Avraham, Marisa Generosa Crespo‐Leiro, Gerasimos Filippatos, Israel Gotsman, Petar Seferovic, Tal Hasin, Luciano Potena, Davor Milicic, Andrew J.S. Coats, Giuseppe Rosano, Frank Ruschitzka, Marco Metra, Stefan Anker, Johann Altenberger, Stamatis Adamopoulos, Yaron D. Barac, Ovidiu Chioncel, Nicolaas De Jonge, Jeremy Elliston, Maria Frigeiro, Eva Goncalvesova, Avishay Grupper, Righab Hamdan, Yoav Hammer, Loreena Hill, Osnat Itzhaki Ben Zadok, Miriam Abuhazira, Jacob Lavee, Wilfried Mullens, Sanemn Nalbantgil, Massimo F. Piepoli, Piotr Ponikowski, Arsen Ristic, Arjang Ruhparwar, Aviv Shaul, Laurens F. Tops, Steven Tsui, Stephan Winnik, Tiny Jaarsma, Finn Gustafsson, and Tuvia Ben Gal

Subjects
LVAD, General description, Emergency medical systems, CPR, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract The accepted use of left ventricular assist device (LVAD) technology as a good alternative for the treatment of patients with advanced heart failure together with the improved survival of the LVAD‐supported patients on the device and the scarcity of donor hearts has significantly increased the population of LVAD‐supported patients. The expected and non‐expected device‐related and patient–device interaction complications impose a significant burden on the medical system exceeding the capacity of the LVAD implanting centres. The ageing of the LVAD‐supported patients, mainly those supported with the ‘destination therapy’ indication, increases the risk for those patients to experience comorbidities common in the older population. The probability of an LVAD‐supported patient presenting with medical emergency to a local emergency department, internal, or surgical ward of a non‐LVAD implanting centre is increasing. The purpose of this trilogy is to supply the immediate tools needed by the non‐LVAD specialized physician: ambulance clinicians, emergency ward physicians, general cardiologists, internists, anaesthesiologists, and surgeons, to comply with the medical needs of this fast‐growing population of LVAD‐supported patients. The different issues discussed will follow the patient's pathway from the ambulance to the emergency department and from the emergency department to the internal or surgical wards and eventually to the discharge home from the hospital back to the general practitioner. In this first part of the trilogy on the management of LVAD‐supported patients for the non‐LVAD specialist healthcare provider, after the introduction on the assist devices technology in general, definitions and structured approach to the assessment of the LVAD‐supported patient in the ambulance and emergency department is presented including cardiopulmonary resuscitation for LVAD‐supported patients.

Published
2021
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2. Heart Failure Association of the European Society of Cardiology position paper on the management of left ventricular assist device‐supported patients for the non‐left ventricular assist device specialist healthcare provider: Part 2: at the emergency department

Author

Davor Milicic, Binyamin Ben Avraham, Ovidiu Chioncel, Yaron D. Barac, Eva Goncalvesova, Avishai Grupper, Johann Altenberger, Maria Frigeiro, Arsen Ristic, Nicolaas De Jonge, Steven Tsui, Jacob Lavee, Giuseppe Rosano, Marisa Generosa Crespo‐Leiro, Andrew J.S. Coats, Petar Seferovic, Frank Ruschitzka, Marco Metra, Stefan Anker, Gerasimos Filippatos, Stamatis Adamopoulos, Miriam Abuhazira, Jeremy Elliston, Israel Gotsman, Righab Hamdan, Yoav Hammer, Tal Hasin, Lorrena Hill, Osnat Itzhaki Ben Zadok, Wilfried Mullens, Sanemn Nalbantgil, Massimo Francesco Piepoli, Piotr Ponikowski, Luciano Potena, Arjang Ruhparwar, Aviv Shaul, Laurens F. Tops, Stephan Winnik, Tiny Jaarsma, Finn Gustafsson, and Tuvia Ben Gal

Subjects
LVAD, Emergency department, Bleeding, Neurological events, Death declaration, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract The improvement in left ventricular assist device (LVAD) technology and scarcity of donor hearts have increased dramatically the population of the LVAD‐supported patients and the probability of those patients to present to the emergency department with expected and non‐expected device‐related and patient–device interaction complications. The ageing of the LVAD‐supported patients, mainly those supported with the ‘destination therapy’ indication, increases the risk for those patients to suffer from other co‐morbidities common in the older population. In this second part of the trilogy on the management of LVAD‐supported patients for the non‐LVAD specialist healthcare provider, definitions and structured approach to the LVAD‐supported patient presenting to the emergency department with bleeding, neurological event, pump thrombosis, chest pain, syncope, and other events are presented. The very challenging issue of declaring death in an LVAD‐supported patient, as the circulation is artificially preserved by the device despite no other signs of life, is also discussed in detail.

Published
2021
Full Text
View/download PDF

3. HFA of the ESC position paper on the management of LVAD‐supported patients for the non‐LVAD specialist healthcare provider Part 3: at the hospital and discharge

Author

Finn Gustafsson, Binyamin Ben Avraham, Ovidiu Chioncel, Tal Hasin, Avishai Grupper, Aviv Shaul, Sanemn Nalbantgil, Yoav Hammer, Wilfried Mullens, Laurens F. Tops, Jeremy Elliston, Steven Tsui, Davor Milicic, Johann Altenberger, Miriam Abuhazira, Stephan Winnik, Jacob Lavee, Massimo Francesco Piepoli, Lorrena Hill, Righab Hamdan, Arjang Ruhparwar, Stefan Anker, Marisa Generosa Crespo‐Leiro, Andrew J.S. Coats, Gerasimos Filippatos, Marco Metra, Giuseppe Rosano, Petar Seferovic, Frank Ruschitzka, Stamatis Adamopoulos, Yaron Barac, Nicolaas De Jonge, Maria Frigerio, Eva Goncalvesova, Israel Gotsman, Osnat Itzhaki Ben Zadok, Piotr Ponikowski, Luciano Potena, Arsen Ristic, Tiny Jaarsma, and Tuvia Ben Gal

Subjects
End of life, Internal Medicine, LVAD, Surgical departments, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract The growing population of left ventricular assist device (LVAD)‐supported patients increases the probability of an LVAD‐ supported patient hospitalized in the internal or surgical wards with certain expected device related, and patient‐device interaction complication as well as with any other comorbidities requiring hospitalization. In this third part of the trilogy on the management of LVAD‐supported patients for the non‐LVAD specialist healthcare provider, definitions and structured approach to the hospitalized LVAD‐supported patient are presented including blood pressure assessment, medical therapy of the LVAD supported patient, and challenges related to anaesthesia and non‐cardiac surgical interventions. Finally, important aspects to consider when discharging an LVAD patient home and palliative and end‐of‐life approaches are described.

Published
2021
Full Text
View/download PDF

4. HFA of the ESC Position paper on the management of LVAD supported patients for the non LVAD specialist healthcare provider Part 1: Introduction and at the non-hospital settings in the community

Author

Miriam Abuhazira, Finn Gustafsson, Yaron D. Barac, Yoav Hammer, Marco Metra, Massimo F Piepoli, Stamatis Adamopoulos, Davor Miličić, Gerasimos Filippatos, Avishay Grupper, Ovidiu Chioncel, Israel Gotsman, Marisa G. Crespo-Leiro, Piotr Ponikowski, Andrew J.S. Coats, Arsen D. Ristić, Nicolaas de Jonge, Binyamin Ben Avraham, Aviv Shaul, Stefan D. Anker, Luciano Potena, Giuseppe M.C. Rosano, Righab Hamdan, Osnat Itzhaki Ben Zadok, Loreena Hill, Laurens F. Tops, Sanemn Nalbantgil, Johann Altenberger, Steven Tsui, Arjang Ruhparwar, Maria Frigeiro, Wilfried Mullens, Tiny Jaarsma, Stephan Winnik, Eva Goncalvesova, Tal Hasin, Jeremy Elliston, Frank Ruschitzka, Tuvia Ben Gal, Jacob Lavee, Petar M. Seferovic, Gustafsson, Finn/0000-0003-2144-341X, Ben Avraham, Binyamin, Crespo-Leiro, Marisa Generosa, Filippatos, Gerasimos, Gotsman, Israel, Seferovic, Petar, Hasin, Tal, Potena, Luciano, Milicic, Davor, Coats, Andrew J. S., Rosano, Giuseppe, Ruschitzka, Frank, Metra, Marco, Anker, Stefan, Altenberger, Johann, Adamopoulos, Stamatis, Barac, Yaron D., Chioncel, Ovidiu, De Jonge, Nicolaas, Elliston, Jeremy, Frigeiro, Maria, Goncalvesova, Eva, Grupper, Avishay, Hamdan, Righab, Hammer, Yoav, Hill, Loreena, Ben Zadok, Osnat Itzhaki, Abuhazira, Miriam, Lavee, Jacob, MULLENS, Wilfried, Nalbantgil, Sanemn, Piepoli, Massimo F., Ponikowski, Piotr, Ristic, Arsen, Ruhparwar, Arjang, Shaul, Aviv, Tops, Laurens F., Tsui, Steven, Winnik, Stephan, Jaarsma, Tiny, Gustafsson, Finn, and Ben Gal, Tuvia

Subjects
Shared Care, LVAD, medicine.medical_treatment, Health Personnel, Population, Social and Clinical Pharmacy, CPR, Emergency medical systems, General description, Hospitals, Humans, Tissue Donors, Heart Transplantation, Heart-Assist Devices, Heart-Assist Devices / adverse effects, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, ESC and HFA Paper, Heart-Failure, ESC and HFA Papers, Ventricular Assist Devices, Older population, Tidal Carbon-Dioxide, medicine, Diseases of the circulatory (Cardiovascular) system, Cardiac-Output, Cardiopulmonary resuscitation, Tachyarrhythmias, education, education.field_of_study, business.industry, Samhällsfarmaci och klinisk farmaci, Mechanical Circulatory Support, Emergency department, Controlled Trial, medicine.disease, equipment and supplies, Implantation, Ventricular assist device, RC666-701, Cardiopulmonary-Resuscitation, Position paper, Medical emergency, Cardiology and Cardiovascular Medicine, business, Healthcare providers, Destination therapy
Abstract

[Abstract] The accepted use of left ventricular assist device (LVAD) technology as a good alternative for the treatment of patients with advanced heart failure together with the improved survival of the LVAD-supported patients on the device and the scarcity of donor hearts has significantly increased the population of LVAD-supported patients. The expected and non-expected device-related and patient-device interaction complications impose a significant burden on the medical system exceeding the capacity of the LVAD implanting centres. The ageing of the LVAD-supported patients, mainly those supported with the 'destination therapy' indication, increases the risk for those patients to experience comorbidities common in the older population. The probability of an LVAD-supported patient presenting with medical emergency to a local emergency department, internal, or surgical ward of a non-LVAD implanting centre is increasing. The purpose of this trilogy is to supply the immediate tools needed by the non-LVAD specialized physician: ambulance clinicians, emergency ward physicians, general cardiologists, internists, anaesthesiologists, and surgeons, to comply with the medical needs of this fast-growing population of LVAD-supported patients. The different issues discussed will follow the patient's pathway from the ambulance to the emergency department and from the emergency department to the internal or surgical wards and eventually to the discharge home from the hospital back to the general practitioner. In this first part of the trilogy on the management of LVAD-supported patients for the non-LVAD specialist healthcare provider, after the introduction on the assist devices technology in general, definitions and structured approach to the assessment of the LVAD-supported patient in the ambulance and emergency department is presented including cardiopulmonary resuscitation for LVAD-supported patients.

Published
2022

5. Heart Failure Association of the European Society of Cardiology position paper on the management of left ventricular assist device-supported patients for the non-left ventricular assist device specialist healthcare provider

Author

Stamatis Adamopoulos, Wilfried Mullens, Avishai Grupper, Miriam Abuhazira, Davor Miličić, Lorrena Hill, Johann Altenberger, Marco Metra, Jacob Lavee, Petar M. Seferovic, Tiny Jaarsma, Laurens F. Tops, Frank Ruschitzka, Tal Hasin, Yoav Hammer, Marisa G. Crespo-Leiro, Gerasimos Filippatos, Jeremy Elliston, Osnat Itzhaki Ben Zadok, Eva Goncalvesova, Righab Hamdan, Andrew J.S. Coats, Massimo F Piepoli, Finn Gustafsson, Luciano Potena, Israel Gotsman, Tuvia Ben Gal, Binyamin Ben Avraham, Piotr Ponikowski, Aviv Shaul, Giuseppe M.C. Rosano, Stefan D. Anker, Steven Tsui, Yaron D. Barac, Arsen D. Ristić, Sanemn Nalbantgil, Arjang Ruhparwar, Maria Frigeiro, Ovidiu Chioncel, Nicolaas de Jonge, Stephan Winnik, Gustafsson, Finn/0000-0003-2144-341X, Milicic, Davor, Ben Avraham, Binyamin, Chioncel, Ovidiu, Barac, Yaron D., Goncalvesova, Eva, Grupper, Avishai, Altenberger, Johann, Frigeiro, Maria, Ristic, Arsen, De Jonge, Nicolaas, Tsui, Steven, Lavee, Jacob, Rosano, Giuseppe, Crespo-Leiro, Marisa Generosa, Coats, Andrew J. S., Seferovic, Petar, Ruschitzka, Frank, Metra, Marco, Anker, Stefan, Filippatos, Gerasimos, Adamopoulos, Stamatis, Abuhazira, Miriam, Elliston, Jeremy, Gotsman, Israel, Hamdan, Righab, Hammer, Yoav, Hasin, Tal, Hill, Lorrena, Ben Zadok, Osnat Itzhaki, MULLENS, Wilfried, Nalbantgil, Sanemn, Piepoli, Massimo Francesco, Ponikowski, Piotr, Potena, Luciano, Ruhparwar, Arjang, Shaul, Aviv, Tops, Laurens F., Winnik, Stephan, Jaarsma, Tiny, Gustafsson, Finn, and Ben Gal, Tuvia

Subjects
Death declaration, LVAD, medicine.medical_treatment, Von-Willebrand-Factor, Chest pain, ESC and HFA Paper, ESC and HFA Papers, Long-Term Support, Risk-Factors, Cardiac and Cardiovascular Systems, Ischemic-Stroke, declaration, education.field_of_study, Emergency Service, Kardiologi, Bleeding, Emergency department, Neurological events, Emergency Service, Hospital, Health Personnel, Humans, Tissue Donors, Cardiology, Heart Failure, Heart Transplantation, Heart-Assist Devices, Mechanical Circulatory Support, Death, Gender-Differences, Blood-Pressure, medicine.symptom, Cardiology and Cardiovascular Medicine, Gastrointestinal Hemorrhage, medicine.medical_specialty, Population, Heart-Assist Devices / adverse effects, Intracerebral Hemorrhage, Hospital, medicine, Diseases of the circulatory (Cardiovascular) system, education, Intracranial Hemorrhage, business.industry, Heart Failure / epidemiology, medicine.disease, equipment and supplies, RC666-701, Ventricular assist device, Heart failure, Emergency medicine, Position paper, business, Healthcare providers, Destination therapy
Abstract

[Abstract] The improvement in left ventricular assist device (LVAD) technology and scarcity of donor hearts have increased dramatically the population of the LVAD-supported patients and the probability of those patients to present to the emergency department with expected and non-expected device-related and patient-device interaction complications. The ageing of the LVAD-supported patients, mainly those supported with the 'destination therapy' indication, increases the risk for those patients to suffer from other co-morbidities common in the older population. In this second part of the trilogy on the management of LVAD-supported patients for the non-LVAD specialist healthcare provider, definitions and structured approach to the LVAD-supported patient presenting to the emergency department with bleeding, neurological event, pump thrombosis, chest pain, syncope, and other events are presented. The very challenging issue of declaring death in an LVAD-supported patient, as the circulation is artificially preserved by the device despite no other signs of life, is also discussed in detail.

Published
2021

6. HFA of the ESC position paper on the management of LVAD-supported patients for the non-LVAD specialist healthcare provider Part 3:at the hospital and discharge

Author

Marco Metra, Binyamin Ben Avraham, Aviv Shaul, Luciano Potena, Ovidiu Chioncel, Finn Gustafsson, Andrew J.S. Coats, Johann Altenberger, Stamatis Adamopoulos, Piotr Ponikowski, Osnat Itzhaki Ben Zadok, Tiny Jaarsma, Avishai Grupper, Arsen D. Ristić, Frank Ruschitzka, Miriam Abuhazira, Lorrena Hill, Stefan D. Anker, Eva Goncalvesova, Tuvia Ben Gal, Marisa G. Crespo-Leiro, Massimo F Piepoli, Sanemn Nalbantgil, Arjang Ruhparwar, Righab Hamdan, Davor Miličić, Wilfried Mullens, Laurens F. Tops, Nicolaas de Jonge, Steven Tsui, Giuseppe M.C. Rosano, Israel Gotsman, Jeremy Elliston, Yaron D. Barac, Yoav Hammer, Maria Frigerio, Jacob Lavee, Petar M. Seferovic, Gerasimos Filippatos, Tal Hasin, Stephan Winnik, Gustafsson, Finn/0000-0003-2144-341X, Gustafsson, Finn, Ben Avraham, Binyamin, Chioncel, Ovidiu, Hasin, Tal, Grupper, Avishai, Shaul, Aviv, Nalbantgil, Sanemn, Hammer, Yoav, MULLENS, Wilfried, Tops, Laurens F., Elliston, Jeremy, Tsui, Steven, Milicic, Davor, Altenberger, Johann, Abuhazira, Miriam, Winnik, Stephan, Lavee, Jacob, Piepoli, Massimo Francesco, Hill, Lorrena, Hamdan, Righab, Ruhparwar, Arjang, Anker, Stefan, Crespo-Leiro, Marisa Generosa, Coats, Andrew J. S., Filippatos, Gerasimos, Metra, Marco, Rosano, Giuseppe, Seferovic, Petar, Ruschitzka, Frank, Adamopoulos, Stamatis, Barac, Yaron, De Jonge, Nicolaas, Frigerio, Maria, Goncalvesova, Eva, Gotsman, Israel, Itzhaki Ben Zadok, Osnat, Ponikowski, Piotr, Potena, Luciano, Ristic, Arsen, Jaarsma, Tiny, and Ben Gal, Tuvia

Subjects
medicine.medical_specialty, End of life, Internal Medicine, LVAD, Surgical departments, medicine.medical_treatment, Health Personnel, Population, Social and Clinical Pharmacy, Noncardiac Surgery, Perioperative Management, Chronic Heart-Failure, ESC and HFA Paper, ESC and HFA Papers, medicine, Diseases of the circulatory (Cardiovascular) system, Humans, Aortic-Valve Insufficiency, Intensive care medicine, education, Internal medicine, Heart Failure, education.field_of_study, business.industry, Samhällsfarmaci och klinisk farmaci, Palliative Care, Mechanical Circulatory Support, medicine.disease, equipment and supplies, Implantation, Hospitals, Patient Discharge, Blood pressure, Ventricular assist device, Heart failure, RC666-701, Blood-Pressure, Liver Dysfunction, Position paper, Heart-Assist Devices, Ventricular Assist Device, business, Complication, Cardiology and Cardiovascular Medicine, Surgical interventions, Healthcare providers
Abstract

[Abstract] The growing population of left ventricular assist device (LVAD)-supported patients increases the probability of an LVAD- supported patient hospitalized in the internal or surgical wards with certain expected device related, and patient-device interaction complication as well as with any other comorbidities requiring hospitalization. In this third part of the trilogy on the management of LVAD-supported patients for the non-LVAD specialist healthcare provider, definitions and structured approach to the hospitalized LVAD-supported patient are presented including blood pressure assessment, medical therapy of the LVAD supported patient, and challenges related to anaesthesia and non-cardiac surgical interventions. Finally, important aspects to consider when discharging an LVAD patient home and palliative and end-of-life approaches are described.

Published
2021

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