Sharing the Care of Mechanical Circulatory Support
2015; Lippincott Williams & Wilkins; Volume: 8; Issue: 3 Linguagem: Inglês
10.1161/circheartfailure.114.001767
ISSN1941-3297
AutoresMichael S. Kiernan, Susan Joseph, Jason N. Katz, Ahmet Kılıç, Jonathan D. Rich, Mark P. Tallman, Peter Van Buren, James Lyons, Brian Bethea, Peter Eckman, Igor Gošev, Sangjin S. Lee, Behzad Soleimani, Hiroo Takayama, Chetan B. Patel, Nir Uriel,
Tópico(s)Cardiac pacing and defibrillation studies
ResumoHomeCirculation: Heart FailureVol. 8, No. 3Sharing the Care of Mechanical Circulatory Support Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBSharing the Care of Mechanical Circulatory SupportCollaborative Efforts of Patients/Caregivers, Shared-Care Sites, and Left Ventricular Assist Device Implanting Centers Michael S. Kiernan, MD, MS, Susan M. Joseph, MD, Jason N. Katz, MD, MHS, Ahmet Kilic, MD, Jonathan D. Rich, MD, Mark P. Tallman, MD, Peter Van Buren, MD, James J. Lyons, MD, Brian Bethea, MD, Peter Eckman, MD, Igor Gosev, MD, Sangjin S. Lee, MD, Behzad Soleimani, MD, Hiroo Takayama, MD, Chetan B. Patel, MD and Nir Uriel, MDfor the Evolving Mechanical Support Research Group (EMERG) Investigators Michael S. KiernanMichael S. Kiernan From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.). , Susan M. JosephSusan M. Joseph From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.). , Jason N. KatzJason N. Katz From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.). , Ahmet KilicAhmet Kilic From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.). , Jonathan D. RichJonathan D. Rich From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.). , Mark P. TallmanMark P. Tallman From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.). , Peter Van BurenPeter Van Buren From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.). , James J. LyonsJames J. Lyons From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.). , Brian BetheaBrian Bethea From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.). , Peter EckmanPeter Eckman From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.). , Igor GosevIgor Gosev From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.). , Sangjin S. LeeSangjin S. Lee From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.). , Behzad SoleimaniBehzad Soleimani From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.). , Hiroo TakayamaHiroo Takayama From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.). , Chetan B. PatelChetan B. Patel From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.). and Nir UrielNir Uriel From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.). and for the Evolving Mechanical Support Research Group (EMERG) Investigators Originally published1 May 2015https://doi.org/10.1161/CIRCHEARTFAILURE.114.001767Circulation: Heart Failure. 2015;8:629–635Left ventricular assist devices (LVADs) improve longevity, as well as functional capacity and quality of life in patients with medically refractory heart failure.1–5 During the 6 years since the US Food and Drug Administration approval of the first commercially available continuous flow LVAD in 2008, the number of patients supported by these devices has grown exponentially. The most recent report from the Interagency Registry for Mechanically Assisted Circulatory Support recorded nearly 2500 North American LVAD implants in 2013 at >150 implanting centers.6 Approximately 40% of LVADs are implanted as an indefinite form of support (ie, destination therapy [DT]), and nearly half of patients are surviving >4 years.6 This combination of improved survival and evolving implant strategies has led to an increasing number of LVAD recipients being integrated into the community and we are observing the growth of an ambulatory LVAD population with a unique set of clinical needs.There are 2 predominant strategies of LVAD implantation. Patients who are not eligible for transplantation because of issues such as advanced age may be considered for an LVAD as DT, implying that they will live the rest of their lives with the LVAD. This is in contrast to patients who undergo LVAD implantation as a temporary support device, to support them while awaiting transplantation. This later strategy is defined as a bridge-to-transplantation, following which, the device will be explanted. Centers implanting LVADs without concomitant transplant programs (designated DT centers) have emerged to provide this therapy, averting the need for travel to more distant transplant centers. Such DT centers operate in conjunction with a VAD/transplant partner in the care of patients awaiting transplantation. Because LVAD implant centers are frequently remotely located from the patients that they serve, a model of shared-care has developed, whereby the continued care of these patients is shared between the implanting centers and local, shared-care sites. We define a shared-care center as a nonimplanting center that collaborates in the care of LVAD patients with the implanting center (Figure). Similarly, although heart transplant recipients also have clinical needs best cared for over time by providers knowledgeable in transplant medicine, once stable after the transplant procedure, much of their routine care is transitioned back to local providers. The International Society of Heart and Lung Transplantation guidelines for the care of the heart transplant recipients provide recommendations on the principles of shared care after heart transplantation.7 Recommendations about the shared-care of LVAD recipients are not yet available.Download figureDownload PowerPointFigure. Shared-care model of left ventricular assist device (LVAD) patient care. Shared-care sites comanage LVAD patients with nontransplant (destination therapy [DT]) as well as transplant/VAD centers. Nontransplant and transplant LVAD centers may comanage patients awaiting cardiac transplantation, whereas DT patients implanted at the nontransplant center are typically managed independently by their implanting center.BTT indicates bridge to transplant.The concept of shared care is grounded on a commitment to patient-centered, advanced heart failure care. Shared-care programs are typically led by a cardiologist with heart failure expertise in collaboration with an advanced practice nurse with subspecialty heart failure training similar to other disease management models.8,9 Currently, there are no defined criteria for becoming a shared-care site, but basic requirements should include on-site training provided by the LVAD vendor, possessing the necessary equipment required to interrogate the LVAD, and the adoption of a collaborative protocol between the shared-care site and the implanting center. A coordinated effort is necessary to ensure that distribution of care does not result in fragmentation of care. A carefully coordinated shared-care partnership seeks to improve patient access to care and quality of life, with the overarching goal of improving clinical outcomes. In this perspective, we discuss perceived advantages, as well as obstacles to the shared-care model from the view points of the implanting center, shared-care site, and patient (Table 1). We elaborate also on the infrastructure thought to be necessary for a successful shared-care program.Table 1. Potential Benefits and Perceived Concerns of the Shared-Care ModelPotential BenefitsPerceived ConcernsImplanting Centers• Extending quality care beyond the walls of the implanting center• Improved allocation of resources by distributing routine post-LVAD care to referring partners• Increase capacity and flexibility for the management of new evaluations and recent implantations• Potential to reduce hospital length of stay given local resources for early monitoring and continued patient education• Increase referral from shared-care sites• Ongoing education of community partners about appropriate patient selection, timing of referral, and pretransfer management preferences of the acutely ill patient• Transfer of care to a less-experienced center may have a negative effect on institutional outcomes• Shift of revenue from ambulatory visits from implanting center to the shared-care siteShared-care Sites• Remain intimately involved in the care of their patients• Become resident experts in the management of patients with LVADs• Increased referral from regional cardiologists as a provider of advanced HF therapies• Maintaining revenue from increased ambulatory visits and potential hospitalizations• Cost of nurse coordinator (although likely HF nurse with other patient care responsibilities)• Need for repeated in-service training• Cost of LVAD-specific console and peripheral supplies• Perceived liability about practicing outside of scope of expertise for inpatient personnel beyond the core LVAD teamPatients• Continuity of care and familiarity with the local providers at the shared-care center• Reduced anxiety about easy and immediate access to local experts in MCS care• Reduced financial burden relate to travelling to clinic appointments• Decreased burden of care placed on caregivers• Initial separation anxiety from implanting LVAD team at time of discharge• Confidence in coordination of care among multiple providersHF indicates heart failure; LVAD, left ventricular assist device; and MCS, mechanical circulatory support.Implanting Center PerspectiveGiven the substantial clinical resources used by this medically complex cohort during long-term follow-up, the dramatic and continued rise of the ambulatory LVAD population can overextend the infrastructure of implanting centers. The multidisciplinary LVAD team personnel are frequently required to function not only as heart failure specialists but also as general cardiologists, primary care providers, and patient resource managers.10 Thus, the adoption of a shared-care model can reduce the provider/center load of chronic LVAD care.Improving Quality of Care in the Early Period After LVAD ImplantationDuring the early period after LVAD
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