Clinical outcomes of multidisciplinary team management in patients supported with left ventricular assist devices


Aurora St. Luke's Medical Center, Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Medical Group-Cardiovascular and Thoracic Surgery


Purpose: Traditional method of care for left ventricular assist device (LVAD) patients at our institution involved an ad hoc group of providers with oversight from a surgical team. Since November 2009, a multidisciplinary team (MDT) approach that includes heart failure/transplant cardiologists, cardiothoracic surgeons, nurse practitioners, LVAD engineers, and a discharge team that partners with rehabilitation and outpatient hemodialysis centers has been in effect. We sought to compare clinical outcomes in LVAD patients between MDT care and the traditional method.

Methods: We retrospectively collected data for 262 consecutive LVAD implantations from January 2005 to December 2012. Of these, 91 were implanted before the initiation of the MDT approach (Group A) and 171 during the MDT approach (Group B). Descriptive statistics were used to analyze data.

Results: Baseline characteristics were similar between the two groups except Group B patients were significantly older (mean age 58 vs. 54 years), had higher incidence of ischemic cardiomyopathy (52% vs. 34%), had worse chronic kidney disease (creatinine of 2.05 vs. 1.57 mg/dl), and were more often on continuous renal replacement therapy (CRRT) prior to LVAD implant (7% vs. 1%). Mortality during index hospitalization was lower in Group B (12% vs. 30%; p

Conclusion: Despite treating older patients with higher incidence of ischemic cardiomyopathy, worse chronic kidney disease and more frequent use of CRRT, we observed improved LOS and survival and reduced readmission rates using the MDT care model. We advocate a standard multidisciplinary approach for LVAD patient care in order to optimize outcomes and reduce health care costs.

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