Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
JACC Heart Fail. 2022 May;10(5):321-332. doi: 10.1016/j.jchf.2022.01.011. Epub 2022 Apr 6.
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.
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.
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.
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.
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.
本研究旨在考察一种新的以患者为中心的时间度量标准，用于衡量左心室辅助装置（LVAD）相关临床护理的院外时间。
尽管 LVAD 植入可以提高晚期心力衰竭患者的生存率和功能能力，但这可能是以患者花费大量时间进行 LVAD 相关医疗保健活动为代价的。
作者回顾性评估了 2008 年 5 月 9 日至 2019 年 12 月 31 日期间在单中心接受连续流 LVAD 的连续患者，并在植入后查询了医疗保健就诊情况，包括所有住院就诊和 LVAD 相关的门诊就诊。确定了患者层面的时间指标，包括有任何医疗保健就诊的天数总数，以及接受护理的总估计时间。主要结局是有 LVAD 存活的天数中，至少进行 1 次医疗保健就诊的天数所占比例（%）。次要结局是有 LVAD 存活的总天数中，接受护理的天数所占比例（%）。
在 373 名患者中，LVAD 存活中位数为 390 天（IQR：158-840 天）。患者中位数有 88 天（IQR：45-161 天）进行了≥1 次医疗保健就诊，占有 LVAD 存活的天数的 23.2%（IQR：16.3%-32.4%）。中位数 6.0%（IQR：2.1%-14.1%）和 15.0%（IQR：10.7%-20.0%）的总存活天数分别用于住院和门诊就诊。患者中位数接受护理的时间为 592 小时（IQR：197-1257 小时），占有 LVAD 存活的总时间的 5.6%（IQR：2.2%-12.7%）。
LVAD 患者超过 1/5 的时间都在进行医疗保健活动。我们的研究结果可以为改善出院后护理服务提供效率和对治疗后护理的期望提供信息。
