Time Spent Engaging in Health Care Among Patients With Left Ventricular Assist Devices.

Objectives: This study aims to examine a novel patient-centered metric of time spent engaging in left ventricular assist device (LVAD)-related clinical care outside the home.
Background: Although LVAD implantation can improve survival and functional capacity in patients with advanced heart failure, this may occur at the expense of significant time spent engaging in LVAD-related health care activities.
Methods: The authors retrospectively assessed consecutive patients at a single center who received a continuous-flow LVAD between May 9, 2008, and December 31, 2019, and queried health care encounters after implantation, including all inpatient encounters and LVAD-related ambulatory encounters. Patient-level time metrics were determined, including the total number of days with any health care encounter, and the total estimated time spent receiving care. The primary outcome was the proportion (%) of days alive with an LVAD spent engaged in at least 1 health care encounter. The secondary outcome was the proportion (%) of total time alive with an LVAD spent receiving care.
Results: Among 373 patients, the median number of days alive with LVAD was 390 (IQR: 158-840 days). Patients had a median number of 88 (IQR: 45-161) days with ≥1 health care encounter, accounting for 23.2% (IQR: 16.3%-32.4%) of their days alive with an LVAD. A median 6.0% (IQR: 2.1%-14.1%) and 15.0% (IQR: 10.7%-20.0%) of total days alive were spent in inpatient and ambulatory encounters, respectively. Patients spent a median of 592 (IQR: 197-1,257) hours receiving care, accounting for 5.6% (IQR: 2.2%-12.7%) of their total time alive with an LVAD.
Conclusions: LVAD patients spent more than 1 of every 5 days engaging in health care. Our findings may inform strategies to improve efficiency of postdischarge care delivery and expectations for post-treatment care.
Competing Interests: Funding Support and Author Disclosures Research reported in this publication was supported, in part, by Northwestern University Clinical and Translational Sciences Institute’s Enterprise Data Warehouse. Dr Ahmad has received consulting fees from Amgen, Teladoc Linvongo, and Pfizer unrelated to this manuscript. Dr Allen has received grant funding from the AHA, NIH, and PCORI; and has received consultative fees from Abbott, ACI Clinical, Boston Scientific, Cytokinetics, and Novartis. Dr Grady has received consulting fees from Amgen, and has received grant funding from the NHLBI and NIH. Dr Rich has received consulting fees from Abbott. Dr Pham serves as a consultant for MedTronic, Abbott, and Abiomed. Dr Wilcox has received grant funding from the AHA and NIH; has received consulting fees from Amgen, Abbott, Abiomed, and Novartis; and serves on the scientific advisory boards for Abiomed and Cytokinetics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)