Hospital discharge for the ventricular assist device patient: historical perspective and description of a successful program.

Patients who are supported with an implantable ventricular assist device (VAD) as a bridge to cardiac transplantation are potential candidates for hospital discharge. Hospital discharge rates in reported clinical series vary from 27% to 60%. Many of the patients included in these series, however, were subjects of premarket approval clinical trials and as such, are bound by rigid eligibility criteria for discharge. According to a voluntary registry maintained by Thermo Cardiosystems, Inc., the postmarket discharge rate in patients supported with the HeartMate VE LVAS is approximately 25%, a number that is artificially low due to incomplete reporting. The postmarket discharge rate at the busiest Thermo Cardiosystems HeartMate VE LVAS centers is 53%. Clearly, discharge rates need to increase if the VAD is ever to be considered a viable destination therapy for end-stage heart failure. The discharge program instituted at The University of Iowa incorporates patient and family training as well as community services education. Between January 1999 and April 2001, fourteen patients received VAD support as a bridge to transplantation with the HeartMate VE LVAS. Thirteen patients (93%) were discharged from the hospital. Eight of the 13 patients have been transplanted after having spent 65.8% +/- 31.4% of their period of blood pump support as an outpatient. Eight of 13 patients (62%) required a total of 20 unplanned repeat hospitalizations. A well defined, aggressively implemented discharge program can adequately prepare the VAD patient for the transition from hospital to home.