Transcript 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
• Talk with VAD Coordinator prior to contacting patient
• Typical diagnosis for reimbursement
– Tricuspid Valve Annuloplasty – v43.3
– May have CAD co-morbidity
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
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ECG monitoring – typically PACED
Case management – risk factor /lifestyle modification
Exercise tolerance – heart failure patient
No blood pressure readings
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)
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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
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
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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
Emergency Procedures – Heartmate II
Call CT
Surgeon on
call
DEVICE IS
RUNNING
Page VAD
Coordinator
•Leave Device Alone
•Assess/Treat Patient
(Volume, Rhythm, HTN
Obstruction: inflow/outflow)
Treat
Arrythmia
Fluid
Resuscitate
RED HEART
Call CT
Surgeon on
call
DEVICE HAS
STOPPED
CHECK
CONNECTIONS
IF TIGHT
DO NOT
CONNECT to
Power Base
Unit
Page VAD
Coordinator
Replace
Controller at
direction of
Surgeon or VAD
Coordinator
Questions…