Thoraxcenter, Department of Cardiology, Cardiovascular Institute, Erasmus MC University Medical Center, Rotterdam, Netherlands.
Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands.
Eur J Cardiothorac Surg. 2024 Sep 2;66(3). doi: 10.1093/ejcts/ezae285.
Left ventricular assist devices (LVADs) are increasingly implanted in patients with advanced heart failure. Currently, LVAD care is predominantly concentrated at specialized tertiary care hospitals. However, the increasing workload and logistical burden for implanting centres pose significant challenges to accessing care for individual patients in remote areas. An emerging approach to LVAD patient management is the use of a shared care model (SCM), which facilitates collaboration between implanting centres and local non-implanting hospitals. This scoping review explores and synthesizes the current scientific evidence on the use of SCMs in LVAD care management. Eligible studies were identified in EMBASE, PubMed MEDLINE, Web of Science, Cochrane and Google Scholar. Findings were synthesized in accordance with PRISMA-ScR guidelines. Of the 950 records screened, five articles met the inclusion criteria. Four review articles focused on the proposed benefits and challenges of using SCMs. Main benefits included improved patient satisfaction and continuity of care. Important challenges were initial education of non-implanting centre staff and maintaining competency. One prospective study showed that absence of LVAD-specific care was associated with impaired survival and higher rates of pump thrombosis and LVAD-related infections. The use of SCMs is a promising approach in the long-term management of LVAD patients. However, sufficient evidence about the impact of SCMs on patients and the healthcare system is not currently available. Standardized protocols based on prospective studies are needed to develop safe and effective shared care for LVAD patients.
左心室辅助装置（LVAD）越来越多地被植入到晚期心力衰竭患者中。目前，LVAD 护理主要集中在专门的三级护理医院。然而，植入中心不断增加的工作量和后勤负担给偏远地区的个别患者获得护理带来了重大挑战。一种新兴的 LVAD 患者管理方法是使用共享护理模式（SCM），它促进了植入中心和当地非植入医院之间的合作。本范围综述探讨并综合了目前关于 SCM 在 LVAD 护理管理中应用的科学证据。在 EMBASE、PubMed MEDLINE、Web of Science、Cochrane 和 Google Scholar 中确定了合格的研究。根据 PRISMA-ScR 指南对研究结果进行了综合分析。在筛选的 950 条记录中，有 5 篇文章符合纳入标准。四篇综述文章重点讨论了使用 SCM 的预期益处和挑战。主要益处包括提高患者满意度和护理连续性。重要的挑战是对非植入中心工作人员进行初步教育以及保持能力。一项前瞻性研究表明，缺乏 LVAD 特定护理与生存率降低以及泵血栓形成和 LVAD 相关感染发生率增加有关。在 LVAD 患者的长期管理中，使用 SCM 是一种很有前途的方法。然而，目前尚无关于 SCM 对患者和医疗体系影响的充分证据。需要基于前瞻性研究的标准化方案来为 LVAD 患者制定安全有效的共享护理。
