Improved aftercare in LVAD patients: Development and feasibility of a smartphone application as a first step for telemonitoring

Schmidt, Thomas A.; Mewes, Philipp; Hoffmann, Jan-Dirk; Aschwege, Frerk Müller-von; Glitza, Jenny I.; Schmitto, Jan D.; Schulte-Eistrup, S.; Sindermann, Jürgen R.; Reiss, Nils

doi:10.1111/aor.13560

Cited by 25 publications

(32 citation statements)

References 29 publications

(66 reference statements)

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“…The therapeutic target range is an international normalized ratio (INR) of 2.0-3.0. Self-determination of INR in the home environment achieves an effective therapeutic setting in 70% (45% to 90%) of the patients (27).…”

Section: Bleedingmentioning

confidence: 99%

Permanent Implantable Cardiac Support Systems

Gummert¹,

Haverich²,

Schmitto³

et al. 2019

Deutsches Ärzteblatt International

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he prevalence of advanced heart failure will continue to increase due to demographic trends and better survival rates for persons with cardiac disease. In Germany, the number of hospital admissions for advanced heart failure continues to steadily increase, especially among people over 65 years of age. Nonetheless, there is a marked reduction in the rate of death due to advanced heart failure, from 63.7 per 100 000 inhabitants in 2006, to 42.8 in 2016. This is especially due to the improved treatment options (1, 2), for which permanent mechanical circulatory support also plays a role. Taking into account current guidelines, registries, and clinical studies, the following provides an overview of the current reality of care of permanent-use implantable mechanical circulatory support systems. Permanent implantable systems of mechanical circulatory support The development of mechanical circulatory support (MCS), from the first fully implantable artificial heart system up to advanced ventricular assist devices (VAD), addresses aspects such as pump size, biocompatibility, durability, effectiveness, and susceptibility to infection (3). Modern VADs generate continuous flow (CF) of blood, and patients who received an implant benefit from improved functional status and higher quality of life. One-year survival after left-ventricle assist device (LVAD) implantation improved to over 80% (68% to 81%), which is better compared to the early pulsatile systems (4, 5). Mortality with the current system is primarily due to treatment-related adverse events. Currently, centrifugal CF pumps for left ventricular support are the primary ones implanted. The first system of this type was the HeartWare ventricular assist device (HVAD). The more recent HeartMate 3 has a fully magnetically levitated vane rotor (6, 7). Biventricular MCS The paracorporeal EXCOR from Berlin Heart GmbH is the clinically most widely used and approved system for biventricular support. This extracorporeal displacement pump is approved for both left-, right-, and biventricular support. It is the only system available for pediatric use (8, 9). Clinically, two CF-LVAD systems have been implanted for biventricular support (10); however, these Summary Background: Nearly 1000 permanent ventricular assist devices (VADs) are implanted in patients with severe congestive heart failure in Germany each year. VADs are miniaturized centrifugal pumps that generate continuous blood flow; they are powered and controlled through a cable that passes through the skin. Paracorporeal systems are only rarely implanted, usually in children. Methods: In this selective review of the literature, including guidelines and registry data, we discuss the indications, therapeutic effects, and complications of permanently implantable cardiac support systems. Results: The optimal time for VAD implantation cannot be precisely defined. A comparative assessment of the various available systems is not possible, as no randomized trials have been performed on this topic. Registry data indicate that 69% to ...

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Section: Bleedingmentioning

confidence: 99%

Permanent Implantable Cardiac Support Systems

Gummert¹,

Haverich²,

Schmitto³

et al. 2019

Deutsches Ärzteblatt International

Self Cite

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“…As with every innovative technology, it will take time for our patients to become acquainted with it. Certain patient groups are already embracing this new technology, provided that support and user-friendliness are given [ 10 ]. Eventually, the benefits for the health care system as well as for the patients themselves will clearly reward efforts to implement telemedicine in daily clinical practice.…”

Section: Discussionmentioning

confidence: 99%

VAD Patients’ Perception of Potential Telemedicine Support

Berg

Benstoem

Moza

2022

IJERPH

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Technical possibilities for patient support must be user-friendly. This includes acceptance on the part of the patients, and safe function that must not lead to the user being overtaxed. In a study of Ventricular Assist Device (VAD) patients at the Department of Thoracic and Cardiovascular Surgery at the University Hospital RWTH Aachen, a questionnaire was used to investigate the current situation in dealing with the VAD system. This was followed by a query about ideas, wishes, and fears regarding the increased use of telemedical applications. An adapted Service User Technology Acceptability Questionnaire (SUTAQ) was used and the evaluation was carried out with the help of Office-based applications. As a result, it can be stated that the patients do not want to see personal contacts and care be completely replaced by telemedical remote support. If the application is stable and functioning, the majority is very much open to such support.

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“…Therefore, specific management algorithms should be implemented by every implanting and referring LVAD center to aim for early diagnosis and treatment of COVID‐19 or LVAD complications. A continuous telemonitoring system based on a fully digitalized structure is surely desirable, 4‐7 yet not available in every LVAD center. On the other side, our telemonitoring algorithm has been designed to be sustainable, enforceable, and adaptable to every LVAD center, regardless of number of LVAD patients or previous experiences.…”

Section: Discussionmentioning

confidence: 99%