Cost of Ventricular Assist Devices

Miller, Leslie W.; Guglin, Maya; Rogers, Joseph G.

doi:10.1161/circulationaha.112.139824

Cited by 78 publications

(41 citation statements)

References 38 publications

(44 reference statements)

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“…In relation to the importance of the hemodynamic monitoring, HR, MAP, CO, SvO 2, and pulse oximetry are widely discussed data in the literature (4,6) aiming at obtaining accurate data from critical patients using a VAD, corroborating the positive consensus of the experts in this study. However, the verification of the pulse, urine output, and temperature also presented favorable consensus among the experts.…”

Section: Discussionsupporting

confidence: 76%

“…Searches in the scientific literature (4)(5)(6)(7)(8)(11)(12)(13)(14)(15)(16) were conducted for the elaboration of the protocol and to carry out the discussion of the variables related to the patient using a ventricle assist device.…”

Section: Study Protocolmentioning

confidence: 99%

“…The main function of VADs consists in ensuring an effective systemic perfusion, avoiding multiple organs dysfunction, providing improvement of the cardiac output and pulmonary edema, reducing the central venous pressure, and reducing the neurohormonal activity activated by the HF. They are characterized according to their use, subdivided in counterpulsation support (intra-aortic balloon pump) and parallel assist (artificial ventricles) (5)(6) . Extracorporeal membrane oxygenation (ECMO) is a shortacting MCS system indicated for cardiogenic shock and respiratory failure when surgical or conventional therapeutic procedures, including the use of an intra-aortic balloon pump, are not successful.…”

Section: Introductionmentioning

confidence: 99%

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Nursing care protocol for patients with a ventricular assist device

Machado

Gironés²,

Souza³

et al. 2017

Rev. Bras. Enferm.

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How to cite this article: Machado RC, Gironés P, Souza AR, Moreira RSL, von Jakitsch CB, Branco JNR. Nursing care protocol for patients with a ventricular assist device. Rev Bras Enferm [Internet]. 2017;70(2):335-41. DOI: http://dx.doi.org/10.1590/0034-7167-2016-0363Submission: 07-21-2016Approval: 10-15-2016 ABSTRACT Objective: to develop and validate a nursing care protocol for patients with a ventricular assist device (VAD). Method: descriptive study, with a quantitative approach, for an instrument's methodological validation. Three stages were conducted: development of the instrument; protocol content validation according to the Delphi technique, and agreement among experts and the scientifi c literature. Results: based on the content validation, a care protocol for patients with a VAD was created and assessed by Spanish experts. Of the 15 items evaluated by means of the content validity index (CVI), 10 presented solid evidence of validation, with Kappa ranging between 0.87 and 1. Conclusion: the method enabled the validation of interventions that will contribute to qualifi ed and standardized care for patients with a VAD. Descriptors: Heart Failure; Assisted Circulation; Validation Studies; Protocols; Nursing Care. RESUMO Objetivo: elaborar e validar um protocolo de cuidados de enfermagem a pacientes com dispositivo de assistência ventricular (DAV). Método: estudo descritivo, com abordagem quantitativa de validação metodológica de instrumento. Seguiram-se três etapas: elaboração do instrumento; validação do conteúdo do protocolo segundo a técnica de Delphi e concordância entre peritos e a literatura científi ca. Resultados: com base na validação do conteúdo, elaborou-se um protocolo referente aos cuidados a paciente em uso de DAV avaliado por peritos/juízes espanhóis. Dos 15 itens avaliados, por meio do Índice de Validade de Conteúdo (IVC), 10 deles apresentaram forte evidência de validação com Kappa que variaram de 0,87 a 1. Conclusão: o método permitiu validar intervenções que contribuirão para um cuidado qualifi cado e uniformizado a pacientes em uso de DAV. Descritores: Insufi ciência Cardíaca; Circulação Assistida; Estudos de Validação; Protocolos; Cuidados de Enfermagem. RESUMENObjetivo: elaborar y validar un protocolo de atención de enfermería a pacientes con dispositivo de asistencia ventricular (DAV). Método: estudio descriptivo, con abordaje cuantitativo, de validación metodológica de instrumento. Se siguieron tres etapas: elaboración del instrumento; validación del contenido del protocolo según técnica de Delphi y concordancia entre expertos y la literatura científi ca. Resultados: en base a la validación del contenido, se elaboró un protocolo referido a la atención de pacientes en uso de DAV, evaluado por expertos/jueces españoles. De los 15 ítems evaluados, mediante el índice de Validez de Contenido (IVC), 10 de ellos presentaron fuerte evidencia de validación con Kappa, variando entre 0,87 y 1. Conclusión: el método permitió validar intervenciones que contribuirán a una atención califi cada y u...

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Section: Discussionsupporting

confidence: 76%

Section: Study Protocolmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Nursing care protocol for patients with a ventricular assist device

Machado

Gironés²,

Souza³

et al. 2017

Rev. Bras. Enferm.

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“…Patients who undergo continuous-flow VAD implantation have significantly higher costs than patients who are medically managed ($360,407 vs. $62,856) but have an increase in quality-adjusted life years (QALY) (1.87 vs 0.37), giving an incremental cost-effectiveness ratio of $198,184 per QALY [57 • ]. This is well above the commonly accepted threshold [58]; however, when considering the incremental cost-effectiveness ratio during the REMATCH era of $802,700 [59], this represents tremendous strides toward reaching the cost-effective benchmark. This trend has been driven by improving patient survival with less frequent complications and hospitalizations and reduced failure requiring device replacement [57 • ].…”

Section: Financial Impactmentioning

confidence: 87%

Current Options and Practices in Long-Term Ventricular Assist Devices

2014

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End-stage heart failure poses a significant problem for patients and a burden on the healthcare system. With a lack of available hearts for transplant, mechanical circulatory support has emerged as a viable treatment option. The first generation ventricular assist device (VAD) showed superior outcomes to optimal medical management. Now with second and third generation continuous-flow VADs available, outcomes have continued to improve. Patients who undergo VAD implantation have superior survival and increased quality of life; however, they also have a significant risk of adverse events. These adverse events are decreasing as newer devices are developed, surgical experience increases, postoperative care improves and patient selection trends toward less critically ill patients. Future progress of the VAD will continue to improve survival and decrease adverse events.

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“…Although the standard therapy for end-stage heart failure is considered to be heart transplantation, the severe shortage of donors limits the wide applicability of this procedure, and the need for immunosuppression impairs the patient's quality of life. Similarly, although surgical interventions, such as the implantation of mechanical ventricular assist devices, are making progress, these interventions can only be applied in a limited number of patients and are associated with immense medical costs 3 . Therefore, the development of a novel strategy to resolve these issues is awaited.…”

Section: Introductionmentioning

confidence: 99%