Hospital discharge for the ventricular assist device patient: Historical perspective and description of a successful program

Patients who are supported with an implantable ventricular assist device (V AD) as a bridge to cardiac transplantation are potential candidates for hos pital discharge. Hospital discharge rates in reported clinical series vary from 27% to 60%. Many of the patients included in these series, however, we re subjects of premarket approval clinical trials and as such, are bound by rigid eligibility criteria for discharge. According to a voluntary registr y maintained by Thermo Cardiosystems, Inc., the postmarket discharge rate i n patients supported with the HeartMate VE LVAS is approximately 25%, a num ber that is artificially low due to incomplete reporting. The postmarket di scharge rate at the busiest Thermo Cardiosystems HeartMate VE LVAS centers is 53%. Clearly, discharge rates need to increase if the VAD is ever to be considered a viable destination therapy for end-stage heart failure. The di scharge program instituted at The University of Iowa incorporates patient a nd family training as well as community services education. Between January 1999 and April 2001, fourteen patients received VAD support as a bridge to transplantation with the HeartMate VE LVAS. Thirteen patients (93%) were d ischarged from the hospital. Eight of the 13 patients have been transplante d after having spent 65.8% +/- 31.4% of their period of blood pump support as an outpatient. Eight of 13 patients (62%) required a total of 20 unplann ed repeat hospitalizations. A well defined, aggressively implemented discha rge program can adequately prepare the VAD patient for the transition from hospital to home.