Objectives

The aim of this study was to evaluate the impact of a shared-care model on outcomes in patients with left ventricular assist devices (LVADs) living in remote locations.

Background

Health care delivery through shared-care models has been shown to improve outcomes in patients with chronic diseases. However, the impact of shared-care models on outcomes in patients with LVAD is unknown.

Methods

LVAD recipients in the authors’ program (2007 to 2018) were classified based on the levels of care provided and training and resources used: level 1, was defined as outpatient primary care without LVAD-specific care; level 2 was level 1 services and outpatient LVAD-specific care; level 3 was level 2 services and inpatient LVAD-specific care and implantation center (IC). The Kaplan-Meier method was used to compare rates of survival, bleeding, pump thrombosis, infection, neurologic events, and readmissions among levels of care.

Results

A total of 336 patients were included, with 255 patients (75.9%) cared for in shared-care facilities. Median follow-up was 810 (interquartile range: 321 to 1,096) days. In comparison to patients cared for by IC, patients at levels 2 and 3 shared-care centers had similar rates of death, bleeding, neurologic events, pump thromboses, and infections. However, the rates of death, pump thromboses, and infections were higher for level 1 patients than in IC patients.

Conclusions

Shared health care is an effective strategy to deliver care to patients with LVAD living in remote locations. However, patients in shared-care facilities unable to provide LVAD-specific care are at higher risk of unfavorable outcomes. Availability of LVAD-specific care should be strongly considered during patient selection and every effort made to ensure LVAD-specific training and resources are available at shared-care facilities.

中文翻译：

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左心辅助设备患者在偏远地区共享医疗的影响。

目标

这项研究的目的是评估共享医疗模式对居住在偏远地区的左心室辅助装置（LVAD）患者预后的影响。

背景

通过共享医疗模式提供的医疗服务已被证明可以改善慢性病患者的预后。但是，共享护理模式对LVAD患者预后的影响尚不清楚。

方法

作者计划（2007年至2018年）的LVAD接受者根据所提供的护理水平，培训和使用的资源进行分类：1级定义为没有LVAD特定护理的门诊初级护理；2级为1级服务和门诊LVAD特定护理；第3级是第2级服务以及住院LVAD特定的护理和植入中心（IC）。Kaplan-Meier方法用于比较各护理级别之间的存活率，出血率，泵血栓形成，感染，神经系统事件和再入院率。

结果

总共包括336名患者，其中255名患者（75.9％）在共享医疗机构中得到护理。中位随访时间为810天（四分位间距：321至1,096）。与由IC护理的患者相比，处于第2级和第3级共享护理中心的患者的死亡，出血，神经系统事件，泵血栓形成和感染率相似。但是，1级患者的死亡率，泵血栓形成和感染率高于IC患者。

结论

共享医疗保健是向居住在偏远地区的LVAD患者提供护理的有效策略。但是，无法提供LVAD特定护理的共享护理机构中的患者发生不良结局的风险更高。在选择患者时，应特别考虑LVAD特定护理的可用性，并尽一切努力确保LVAD特定的培训和资源可在共享护理机构获得。