Post-discharge Considerations and Management Recommendations in Left Ventricular Assist Device Recipients

As left ventricular assist device (LVAD) patients transition from one phase of care to another, the transition which almost certainly generates the greatest anxiety is the one to home. Whereas prior in-hospital transfers may have altered nursing to patient staffing ratios and intensity of monitoring, none of those transfers eliminated it. The emotional security blanket afforded the patient and caregiver by being in the hospital is gone; replaced solely by trust in the device’s reliability and the assurances of the medical staff that “it will be fine.” The properly educated patient is nonetheless acutely aware of the pitfalls that may be encountered, sometimes without warning. To help minimize these pitfalls and optimize outcomes, most teams utilize a combination of education, protocol-driven management, outpatient nursing visits, office nursing visits, and frequent telecommunication. Successful post-operative management of the outpatient with a durable LVAD is greatly dependent on pre-discharge educational efforts. Given the relatively small number of patients living with durable LVADs in the community it is not surprising that most local emergency medical services and paramedics are unfamiliar with emergency management. It would be most accurate to conclude that the care of the LVAD recipient is a journey. Unlike that of post heart transplantation care, where the challenges become less over time, the challenges with post-discharge LVAD care are always present.