Functional Status and Discharge Location of Patients Post–Left Ventricular Assist Devices Surgery in the Acute Care Setting

Abstract

This study was approved by the Washington University Human Protection Office (#201810227).Purpose: Left ventricular assist devices (LVAD) are an alternative treatment for patients with heart failure. The purposes of this study were to describe patients immediately post-LVAD surgery, determine differences between functional outcome measures and discharge location, and the potential for initial Functional Status Score of the Intensive Care Unit (FSS-ICU) to assist in discharge recommendations. Methods: A retrospective study (n 5 100) was conducted with the following data obtained: general demographics, FSS-ICU, ICU Mobility Scale (IMS), maximal ambulation distance, and discharge location. Patients were divided into 2 groups based on discharge location (home vs facility). Results: The mean age was 52.8 years, with 64% male. A significant improvement in all functional outcomes was observed from evaluation to discharge. Patients discharged home (76%) exhibited significantly higher FSS-ICU and IMS scores and tolerated out-of-bed activity and ambulation earlier. A score of 14 or higher on the initial FSS-ICU was predictive for discharge to home recommendation. Conclusion: Patients post-LVAD implantation exhibited low levels of functional mobility initially, yet were able to tolerate early activity. Patients discharged home had higher functional scores during the initial evaluation. Using the results of the FSS-ICU may assist in discharge recommendations; further research is needed.

Cardiovascular and Pulmonary Research: The Year (2022) in Review

“…2 Several secondary outcomes, ICU length of stay (LOS), and number of PT visits, had similar statistically significant differences between the same groups. 2 In short, persons who were discharged home had higher levels of function, reduced LOS, and required less therapy than those patients who were discharged to a rehabilitation facility. 2 In a secondary analysis of the FSS-ICU, the authors found that a score of $14 predicted a home discharge with a sensitivity of 70% and a specificity of 79% with a positive predictive value of 91%.…”

“…2 This 2-year retrospective study included patients who had undergone implantation of an LVAD for any reason, who had received PT, and who had not died before discharge. 2 Patient demographics in the study by Fick et al 2 correlated with a recent publication by Okoh et al 3 on racial disparities in LVAD implantation and outcomes that would support a broader application of the findings in the article by Fick et al 2 Statistically significant differences were noted between persons discharged home versus discharge to a facility in most primary study outcomes, namely the FSS-ICU, the Intensive-Care Unit Mobility Score (IMS), and the ambulation distance of the patient, measured in feet. 2 Several secondary outcomes, ICU length of stay (LOS), and number of PT visits, had similar statistically significant differences between the same groups.…”

“…2 Patient demographics in the study by Fick et al 2 correlated with a recent publication by Okoh et al 3 on racial disparities in LVAD implantation and outcomes that would support a broader application of the findings in the article by Fick et al 2 Statistically significant differences were noted between persons discharged home versus discharge to a facility in most primary study outcomes, namely the FSS-ICU, the Intensive-Care Unit Mobility Score (IMS), and the ambulation distance of the patient, measured in feet. 2 Several secondary outcomes, ICU length of stay (LOS), and number of PT visits, had similar statistically significant differences between the same groups. 2 In short, persons who were discharged home had higher levels of function, reduced LOS, and required less therapy than those patients who were discharged to a rehabilitation facility.…”

“…2 This 2-year retrospective study included patients who had undergone implantation of an LVAD for any reason, who had received PT, and who had not died before discharge. 2 Patient demographics in the study by Fick et al 2 correlated with a recent publication by Okoh et al 3 on racial disparities in LVAD implantation and outcomes that would support a broader application of the findings in the article by Fick et al 2…”

Transitions and New Ideas

“…Their results suggest that the revised sternal precautions could improve mobility in patients after cardiac surgery. On another important topic, Ann Fick et al 3 studied the application of the Functional Status Score of the Intensive Care Unit (FSS-ICU) to predict discharge location of patients after left ventricular assistive device surgery. The authors were able to determine a cutoff score of 14 in the FSS-ICU to discharge patients to home.…”