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A standardized telephone intervention algorithm improves the survival of ventricular assist device outpatients
AuthorSchlöglhofer, Thomas ; Necid, Georg ; Moscato, Francesco ; Angleitner, Philipp ; Horvat, Johann ; Hartner, Zeno ; Wiedemann, Dominik ; Dimitrov, Kamen ; Schwingenschlögl, Harald ; Schima, Heinrich ; Riebandt, Julia ; Zimpfer, Daniel
Published in
Artificial Organs, 2018, Vol. 42, Issue 10, page 961-969
PublishedWiley-Blackwell, 2018
Document typeJournal Article
Keywords (EN)Ventricular assist device / Mechanical circulatory support / Outpatient management / Readmission / Algorithm
URNurn:nbn:at:at-ubmuw:3-150 Persistent Identifier (URN)
 The work is publicly available
A standardized telephone intervention algorithm improves the survival of ventricular assist device outpatients [0.7 mb]
Abstract (English)

Ventricular assist devices (VADs) are an established therapeutic option for patients with chronic heart failure. Continuous monitoring of VAD parameters and their adherence to guidelines are crucial to detect problems in an early stage to optimize outcomes. A telephone intervention algorithm for VAD outpatients was developed, clinically implemented and evaluated. During the phone calls, a structured inquiry of pump parameters, alarms, blood pressure, INR, body weight and temperature, exitsite status and heart failure symptoms was performed and electronically categorized by an algorithm into 5 levels of severity. VAD outpatient outcomes without (n=71) and with biweekly telephone interviews in their usual care (n=25) were conducted using proportional hazard Cox regression, with risk adjustment based on a propensity score model computed from demographics and risk factors. From February 2015 through October 2017, 25 patients (n=3 HeartMate II, n=4 HeartMate 3 and n=18 HeartWare HVAD) underwent 637 telephone interventions. In 57.5% of the calls no problems were identified, 3.9% were recalled on the next day because of alarms. In 26.5% (n=169), the VAD Coordinator had to refer to the physician due to elevated blood pressure (n=125, >85 mm Hg), INR<2.0 or>4.0 (n=24) or edema (n=10), 11.9% of the calls led to a followup because of equipment or exitsite problems. Propensityadjusted 2year survival (89% vs. 57%, P=0.027) was significantly higher for the telephone intervention group. Continuous, standardized communication with VAD outpatients is important for early detection of upcoming problems and leads to significantly improved survival.

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