Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah.
Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Department of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah; George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, Utah.
JACC Heart Fail. 2020 Apr;8(4):302-312. doi: 10.1016/j.jchf.2020.01.004.
The aim of this study was to evaluate the impact of a shared-care model on outcomes in patients with left ventricular assist devices (LVADs) living in remote locations.
Health care delivery through shared-care models has been shown to improve outcomes in patients with chronic diseases. However, the impact of shared-care models on outcomes in patients with LVAD is unknown.
LVAD recipients in the authors' program (2007 to 2018) were classified based on the levels of care provided and training and resources used: level 1, was defined as outpatient primary care without LVAD-specific care; level 2 was level 1 services and outpatient LVAD-specific care; level 3 was level 2 services and inpatient LVAD-specific care and implantation center (IC). The Kaplan-Meier method was used to compare rates of survival, bleeding, pump thrombosis, infection, neurologic events, and readmissions among levels of care.
A total of 336 patients were included, with 255 patients (75.9%) cared for in shared-care facilities. Median follow-up was 810 (interquartile range: 321 to 1,096) days. In comparison to patients cared for by IC, patients at levels 2 and 3 shared-care centers had similar rates of death, bleeding, neurologic events, pump thromboses, and infections. However, the rates of death, pump thromboses, and infections were higher for level 1 patients than in IC patients.
Shared health care is an effective strategy to deliver care to patients with LVAD living in remote locations. However, patients in shared-care facilities unable to provide LVAD-specific care are at higher risk of unfavorable outcomes. Availability of LVAD-specific care should be strongly considered during patient selection and every effort made to ensure LVAD-specific training and resources are available at shared-care facilities.
本研究旨在评估远程居住的左心室辅助装置（LVAD）患者共享护理模式对结局的影响。
通过共享护理模式提供医疗服务已被证明可改善慢性病患者的结局。然而，共享护理模式对 LVAD 患者结局的影响尚不清楚。
根据提供的护理水平和使用的培训和资源，对作者所在项目（2007 年至 2018 年）中的 LVAD 接受者进行分类：1 级为无 LVAD 特定护理的门诊初级保健；2 级为 1 级服务加门诊 LVAD 特定护理；3 级为 2 级服务加 LVAD 特定护理和植入中心（IC）。使用 Kaplan-Meier 法比较不同护理水平的生存率、出血、泵血栓形成、感染、神经事件和再入院率。
共纳入 336 例患者，其中 255 例（75.9%）在共享护理机构接受治疗。中位随访时间为 810 天（四分位距：321 至 1096）。与在 IC 接受治疗的患者相比，在 2 级和 3 级共享护理中心接受治疗的患者的死亡率、出血、神经事件、泵血栓形成和感染率相似。然而，1 级患者的死亡率、泵血栓形成和感染率高于 IC 患者。
共享医疗保健是向远程居住的 LVAD 患者提供护理的有效策略。然而，无法提供 LVAD 特定护理的共享护理机构的患者发生不良结局的风险更高。在患者选择时应强烈考虑 LVAD 特定护理的可及性，并尽一切努力确保共享护理机构能够获得 LVAD 特定培训和资源。
