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Managing the LVAD patient in Cardiac Rehabilitation

Managing the LVAD patient in Cardiac Rehabilitation. 2012 NWCVPR Annual Conference MultiCare Health System Tacoma General Hospital Cardiac Health and Rehabilitation Program. Enrolling the LVAD Patient. Start program 6+ weeks after hospital discharge

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Managing the LVAD patient in Cardiac Rehabilitation

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  1. Managing the LVAD patientin Cardiac Rehabilitation 2012 NWCVPR Annual Conference MultiCare Health System Tacoma General Hospital Cardiac Health and Rehabilitation Program

  2. Enrolling the LVAD Patient • Start program 6+ weeks after hospital discharge • Talk with VAD Coordinator prior to contacting patient • Typical diagnosis for reimbursement • Tricuspid Valve Annuloplasty – v43.3 • May have CAD co-morbidity

  3. Program Overview • Intake Interview – RN • Montana Outcomes • Minnesota Living with Heart Failure® Questionnaire (VAD study) • 1:1 Exercise Evaluation – CES • 6 Minute Walk Test (VAD study) – potential for separate billing • Exercise Equipment Orientation • Exercise Prescription • Monitored Exercise and Education Classes • ECG monitoring – typically PACED • Case management – risk factor /lifestyle modification • Exercise tolerance – heart failure patient • No blood pressure readings

  4. Program Considerations • Measurement of specific parameters (signs and symptoms, functional limitations, quality of life) • determine specific patient benefit and overall program outcomes • assess and treat as heart failure patient • Help monitor overall medical plan • optimization of medication use • monitoring of daily weights • compliance with sodium restriction • surveillance for potential exacerbations • Education program designed for heart failure patients • Report signs and symptoms of infection (area of drive insertion)

  5. Exercise Training Considerations • Cycling should be assessed for on an individual basis because of the location of the external drive • Hip flexion may be somewhat limited – important to include activities that prevent disuse and to facilitate the return to functional activities • Symptoms of lightheadedness or dizziness • Device has internal sensor that increases flow rate as needed during exercise, sensor may fail, can be manually increased • Symptom limited exercise

  6. LVAD Function with Exercise • LVAD rate can increase automatically as the device senses the volume of blood in the pump chamber, or rate may be controlled manually • The native left ventricle (LV) continues to contract during LVAD function • Rest – LVAD contributes virtually all the cardiac output • Exercise – native LV contributes varying amount of the total cardiac output • Degree of LV contribution is dependant upon degree of LV dysfunction

  7. Our Experience at Tacoma General Hospital • In-service from VAD Coordinator prior to enrolling patients • Developed emergency procedure (modified Sacred Heart’s) • First Patient in October 2009 • 5 total patients • 3 Medicare, 2 Medicaid • 4 completed program, 1 current patient

  8. Emergency Procedures – Heartmate II • Leave Device Alone • Assess/Treat Patient (Volume, Rhythm, HTN • Obstruction: inflow/outflow) IF TIGHT

  9. Questions…

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