Nursing Education and Implications for LVAD Therapy
The HeartMate VE Left Ventricular Assist Device (vented electric abdominally positioned pulsatile blood pump; Thoratec Corp., Pleasanton, CA), approved as a permanent support, or destination therapy, by the US Food and Drug Administration in 2002 and Medicare in 2003, is now a potential therapy for numerous patients. Postimplantation nursing care is crucial to the success of left ventricular support device therapy and long-term recipient outcome. Nurses also contribute to cost containment, making this a viable treatment for the facility and the patient. Consequently, nurses must be educated about left ventricular assist device concepts and challenges, the benefits of device placement, intensive care unit and postintensive care unit daily care requirements, and outpatient preparation. This knowledge will enable nurses to provide necessary care and to educate recipients, families, and community health care providers on how to give appropriate posthospital care.
The American Heart Association estimates 4.7 million Americans currently experience heart failure. Each year approximately 60,000 develop ischemic or idiopathic cardiomyopathyend-stage heart failure. With subsequent decreases in cardiac output and oxygenation, such patients become unable to carry out normal functions. As the disease progresses, other organs also fail. There is a 1-year mortality rate >50% for those with advanced disease.
Patients initially receive pharmacologic support, such as diuretics, β blockers, and angiotensin-converting enzyme inhibitors; nevertheless, as their disease progresses, medications eventually fail to control their condition. Although heart transplantation provides the gold standard treatment for these patients, a limited donor pool makes this option available only to approximately 2200 patients per year. In all likelihood, many patients will die before donor hearts become available.
Consequently, other long-term interventions are needed. The National Institutes of Health supported the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial at 22 hospitals nationwide to evaluate the efficacy of the vented electric (VE) HeartMate (Thoratec Corp., Pleasanton, CA) left ventricular assist device (LVAD) vs. medical therapy. Following the REMATCH trial's positive results, the US Food and Drug Administration (FDA) approved the HeartMate VE LVAD in November 2002 as permanent support for patients who do not qualify for a heart transplant. This is also known as destination therapy.
After the FDA's approval and the Medicare Coverage Advisory Committee recommendation, Medicare and Medicaid Services approved national insurance coverage for the HeartMate VE LVAD as destination therapy in October 2003. This was the final catalyst for many additional patients to receive the devices.
With the new expanded indications, implant facilities must appropriately educate more nurses to provide care for these patients in their intensive care units (ICUs) and progressive units. Local emergency department nurses, other nurses, and emergency medical services (EMS) personnel also require education about the specialized needs of this population, since they may treat LVAD recipients emergently or for unrelated medical conditions.
Other authors have addressed LVAD function, identified specific ICU concerns, and described LVAD devices. The purposes of this review are to provide an overview of how one facility provides LVAD education for nurses, patients, families, and community health care providers and to identify new educational issues that have emerged as LVAD therapy is used in a broader patient base, including destination therapy.
The HeartMate VE Left Ventricular Assist Device (vented electric abdominally positioned pulsatile blood pump; Thoratec Corp., Pleasanton, CA), approved as a permanent support, or destination therapy, by the US Food and Drug Administration in 2002 and Medicare in 2003, is now a potential therapy for numerous patients. Postimplantation nursing care is crucial to the success of left ventricular support device therapy and long-term recipient outcome. Nurses also contribute to cost containment, making this a viable treatment for the facility and the patient. Consequently, nurses must be educated about left ventricular assist device concepts and challenges, the benefits of device placement, intensive care unit and postintensive care unit daily care requirements, and outpatient preparation. This knowledge will enable nurses to provide necessary care and to educate recipients, families, and community health care providers on how to give appropriate posthospital care.
The American Heart Association estimates 4.7 million Americans currently experience heart failure. Each year approximately 60,000 develop ischemic or idiopathic cardiomyopathyend-stage heart failure. With subsequent decreases in cardiac output and oxygenation, such patients become unable to carry out normal functions. As the disease progresses, other organs also fail. There is a 1-year mortality rate >50% for those with advanced disease.
Patients initially receive pharmacologic support, such as diuretics, β blockers, and angiotensin-converting enzyme inhibitors; nevertheless, as their disease progresses, medications eventually fail to control their condition. Although heart transplantation provides the gold standard treatment for these patients, a limited donor pool makes this option available only to approximately 2200 patients per year. In all likelihood, many patients will die before donor hearts become available.
Consequently, other long-term interventions are needed. The National Institutes of Health supported the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial at 22 hospitals nationwide to evaluate the efficacy of the vented electric (VE) HeartMate (Thoratec Corp., Pleasanton, CA) left ventricular assist device (LVAD) vs. medical therapy. Following the REMATCH trial's positive results, the US Food and Drug Administration (FDA) approved the HeartMate VE LVAD in November 2002 as permanent support for patients who do not qualify for a heart transplant. This is also known as destination therapy.
After the FDA's approval and the Medicare Coverage Advisory Committee recommendation, Medicare and Medicaid Services approved national insurance coverage for the HeartMate VE LVAD as destination therapy in October 2003. This was the final catalyst for many additional patients to receive the devices.
With the new expanded indications, implant facilities must appropriately educate more nurses to provide care for these patients in their intensive care units (ICUs) and progressive units. Local emergency department nurses, other nurses, and emergency medical services (EMS) personnel also require education about the specialized needs of this population, since they may treat LVAD recipients emergently or for unrelated medical conditions.
Other authors have addressed LVAD function, identified specific ICU concerns, and described LVAD devices. The purposes of this review are to provide an overview of how one facility provides LVAD education for nurses, patients, families, and community health care providers and to identify new educational issues that have emerged as LVAD therapy is used in a broader patient base, including destination therapy.
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