Does the distance between residency and implanting center affect the outcome of patients supported by left ventricular assist devices? A multicenter Italian study on radial mechanically assisted circulatory support (MIRAMACS) analysis

Abstract

Background Patients with LVAD require continuous monitoring and care, and since Implanting Centers (ICs) are more experienced in managing LVAD patients than other healthcare facilities, the distance between patient residency and IC could negatively affect the outcomes. Methods Data of patients discharged after receiving an LVAD implantation between 2010 and 2021 collected from the MIRAMACS database were retrospectively analyzed. The population was divided into two groups: A (n = 175) and B (n = 141), according to the distance between patient residency and IC ≤ or >90 miles. The primary endpoint was freedom from Adverse Events (AEs), a composite outcome composed of death, cerebrovascular accident, hospital admission because of GI bleeding, infection, pump thrombosis, and right ventricular failure. Secondary endpoints were incidences of mortality and complications. All patients were followed‐up regularly, according to participating center protocols. Results Baseline clinical characteristics and indications for LVAD did not differ between the two groups. The mean duration of support was 25.5 ± 21 months for Group A and 25.7 ± 20 months for Group B (p = 0.79). At 3 years, freedom from AEs was similar between Group A and Group B (p = 0.36), and there were no differences in rates of mortality and LVAD‐related complications. Conclusions Distance from the IC does not represent a barrier to successful outcomes as long as regular and continuous follow‐up is provided.

The impact of the distance between patient residency and heart transplant center on outcomes after heart transplantation

“…In addition to the scheduled ambulatory visits, patient remote monitoring provides for the real‐time exchange of clinical information, while shared‐care by means of local facilities is consistent and convenient for patients requiring hospitalization. In fact, it is interesting to note that the three groups reported similar outcomes even though outpatient visits were less likely performed in HTC in group C, and rates of hospitalization in local facilities were more common in groups B and C. This figure further confirms recent findings that underline the positive role of a continuous monitoring for patients supported by left ventricular assist device (LVAD) 16 . Similar to HTx recipients, LVAD patients require a thorough and specialized monitoring, and living at distance from the implanting center has been traditionally considered as a concern 17 …”

“…(LVAD). 16 Similar to HTx recipients, LVAD patients require a thorough and specialized monitoring, and living at distance from the implanting center has been traditionally considered as a concern. 17 Shared healthcare programs have proven to be effective strategies in delivering care and improving outcomes in multiple complex and chronic conditions, [18][19][20][21][22] and a strict network between HTC and remote shared-care facilities could have represented an important tool for guaranteeing optimal follow-up when patient residency is far from HTC.…”