Does the distance between residency and implanting center affect the outcome of patients supported by left ventricular assist devices? A multicenter Italian study on radial mechanically assisted circulatory support (MIRAMACS) analysis.
distance
left ventricular assist device
outcomes
Journal
Artificial organs
ISSN: 1525-1594
Titre abrégé: Artif Organs
Pays: United States
ID NLM: 7802778
Informations de publication
Date de publication:
Sep 2022
Sep 2022
Historique:
revised:
16
02
2022
received:
07
01
2022
accepted:
13
06
2022
pubmed:
21
6
2022
medline:
25
8
2022
entrez:
20
6
2022
Statut:
ppublish
Résumé
Patients with LVAD require continuous monitoring and care, and since Implanting Centers (ICs) are more experienced in managing LVAD patients than other healthcare facilities, the distance between patient residency and IC could negatively affect the outcomes. Data of patients discharged after receiving an LVAD implantation between 2010 and 2021 collected from the MIRAMACS database were retrospectively analyzed. The population was divided into two groups: A (n = 175) and B (n = 141), according to the distance between patient residency and IC ≤ or >90 miles. The primary endpoint was freedom from Adverse Events (AEs), a composite outcome composed of death, cerebrovascular accident, hospital admission because of GI bleeding, infection, pump thrombosis, and right ventricular failure. Secondary endpoints were incidences of mortality and complications. All patients were followed-up regularly, according to participating center protocols. Baseline clinical characteristics and indications for LVAD did not differ between the two groups. The mean duration of support was 25.5 ± 21 months for Group A and 25.7 ± 20 months for Group B (p = 0.79). At 3 years, freedom from AEs was similar between Group A and Group B (p = 0.36), and there were no differences in rates of mortality and LVAD-related complications. Distance from the IC does not represent a barrier to successful outcomes as long as regular and continuous follow-up is provided.
Sections du résumé
BACKGROUND
BACKGROUND
Patients with LVAD require continuous monitoring and care, and since Implanting Centers (ICs) are more experienced in managing LVAD patients than other healthcare facilities, the distance between patient residency and IC could negatively affect the outcomes.
METHODS
METHODS
Data of patients discharged after receiving an LVAD implantation between 2010 and 2021 collected from the MIRAMACS database were retrospectively analyzed. The population was divided into two groups: A (n = 175) and B (n = 141), according to the distance between patient residency and IC ≤ or >90 miles. The primary endpoint was freedom from Adverse Events (AEs), a composite outcome composed of death, cerebrovascular accident, hospital admission because of GI bleeding, infection, pump thrombosis, and right ventricular failure. Secondary endpoints were incidences of mortality and complications. All patients were followed-up regularly, according to participating center protocols.
RESULTS
RESULTS
Baseline clinical characteristics and indications for LVAD did not differ between the two groups. The mean duration of support was 25.5 ± 21 months for Group A and 25.7 ± 20 months for Group B (p = 0.79). At 3 years, freedom from AEs was similar between Group A and Group B (p = 0.36), and there were no differences in rates of mortality and LVAD-related complications.
CONCLUSIONS
CONCLUSIONS
Distance from the IC does not represent a barrier to successful outcomes as long as regular and continuous follow-up is provided.
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1932-1936Informations de copyright
© 2022 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.
Références
Molina EJ, Shah P, Kiernan MS, Cornwell WK 3rd, Copeland H, Takeda K, et al. The Society of Thoracic Surgeons Intermacs 2020 annual report. Ann Thorac Surg. 2021 Mar;111(3):778-92.
McNamara N, Narroway H, Williams M, Brookes J, Farag J, Cistulli D, et al. Contemporary outcomes of continuous-flow left ventricular assist devices-a systematic review. Ann Cardiothorac Surg. 2021 Mar;10(2):186-208.
Schima H, Schlöglhofer T, Zu Dohna R, Drews T, Morshuis M, Roefe D, et al. Usability of ventricular assist devices in daily experience: a multicenter study. Artif Organs. 2014 Sep;38(9):751-60.
Loforte A, Gliozzi G, Attisani M, et al. Multicenter Italian study on radial mechanically assisted circulatory support (MIRAMACS): preliminary results. J Heart Lung Transplant. 2021;40:S421-2. https://doi.org/10.1016/j.healun.2021.01.1180
Ravichandran AK, Shah P, Singh R, Aaronson KD, Pagani FD, Stulak J, Dunlay SM, Dardas TF, Mokadam NA, Salerno CT, Cowger JA Impact of patient distance from ventricular assist device-implanting center on short- and long-term outcomes. ASAIO J 2018 Nov/Dec;64(6):721-726.
Kelly C, Hulme C, Farragher T, Clarke G. Are differences in travel time or distance to healthcare for adults in global north countries associated with an impact on health outcomes? A systematic review. BMJ Open. 2016 Nov 24;6(11):e013059.
Goldberg DS, Newcomb C, Gilroy R, Sahota G, Wallace AE, Lewis JD, et al. Increased distance to a liver transplant center is associated with higher mortality for patients with chronic liver failure. Clin Gastroenterol Hepatol. 2017 Jun;15(6):958-60.
Powell-Chandler A, Khalid U, Horvath S, Ilham MA, Asderakis A, Stephens MR. The impact of distance from transplant unit on outcomes following kidney transplantation. Int J Surg. 2017 Oct;46:21-6.
Walter C, Fischer F, Hanke JS, Dogan G, Schmitto JD, Haverich A, et al. Infrastructural needs and expected benefits of telemonitoring in left ventricular assist device therapy: results of a qualitative study using expert interviews and focus group discussions with patients. Int J Artif Organs. 2020 Jun;43(6):385-92.
Schroeder SE, Boschi S, Schlöglhofer T. The role of the ventricular assist device coordinator: quo vadis? Ann Cardiothorac Surg. 2021 May;10(3):386-8.
Johnson CE, Saunders CM, Phillips M, Emery JD, Nowak AK, Overheu K, et al. Randomized controlled trial of shared care for patients with cancer involving general practitioners and cancer specialists. J Oncol Pract. 2015 Sep;11(5):349-55.
Yin MY, Strege J, Gilbert EM, Stehlik J, McKellar SH, Elmer A, et al. Impact of shared care in remote areas for patients with left ventricular assist devices. JACC Heart Fail. 2020 Apr;8(4):302-12.
Givertz MM, DeFilippis EM, Colvin M, Darling CE, Elliott T, Hamad E, et al. HFSA/SAEM/ISHLT clinical expert consensus document on the emergency management of patients with ventricular assist devices. J Heart Lung Transplant. 2019 Jul;38(7):677-98.