From the School of Nursing, Johns Hopkins University, Baltimore, Maryland.
Columbia University Medical Center, New York City, New York.
ASAIO J. 2021 Jun 1;67(6):658-665. doi: 10.1097/MAT.0000000000001381.
The purpose of this study was to explore the information reported by patients via a smartphone application (VAD Care App) used for left ventricular assist device (LVAD) self-care monitoring and reporting post hospital discharge. Specific aims were to examine the type and frequency of issues reported by patients through the app during months 1, 3, and 6 postdischarge. An exploratory-descriptive research design was used with 17 patients (12 males and 5 females) with durable LVADs, mean age of 48.6 ± 16 years. Data generated by the patients' daily smartphone app usage more than 6 months were extracted from the server. Data were coded and clustered according to issues reported by patients via the app and analyzed with descriptive statistics. Three clusters of issues were found: physiologic, behavioral (self-care), and signs and symptoms. LVAD flows and pulsatility indices, hypertension, driveline care, and heart failure symptoms were worse at month 1, and then appeared to improve at months 3-6. However, abnormal levels of the international normalization ratio were common at all assessment points. Further research is needed to understand the mechanism of the reported issues on treatment outcomes, then develop and test interventions to inform evidence-based practice and clinical guidelines for smartphone apps used in LVAD self-care monitoring.
本研究旨在探讨患者通过智能手机应用程序（VAD Care App）报告的信息，该应用程序用于左心室辅助装置（LVAD）出院后的自我护理监测和报告。具体目的是检查患者在出院后第 1、3 和 6 个月通过应用程序报告的问题的类型和频率。采用探索性描述性研究设计，纳入 17 名耐用性 LVAD 患者（12 名男性，5 名女性），平均年龄为 48.6 ± 16 岁。从服务器中提取患者使用智能手机应用程序超过 6 个月的日常数据。根据患者通过应用程序报告的问题对数据进行编码和聚类，并进行描述性统计分析。发现了三个问题簇：生理、行为（自我护理）和体征和症状。LVAD 流量和脉动指数、高血压、驱动线护理和心力衰竭症状在第 1 个月时更差，然后在第 3-6 个月似乎有所改善。然而，国际标准化比值的异常水平在所有评估点都很常见。需要进一步研究了解报告问题对治疗结果的机制，然后开发和测试干预措施，为基于证据的实践和 LVAD 自我护理监测中使用的智能手机应用程序的临床指南提供信息。
