Effects Of Decreased Access To Outpatient Care During The Covid-19 Pandemic
HFSA ePoster Library. Crowley J. 09/10/21; 343480; 246
Jillian Crowley
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Abstract
Discussion Forum (0)
Objective: While implantation of a left ventricular assist device (LVAD) in patients with Stage D heart failure (HF) can prolong survival, this often occurs at the expense of increased time spent in LVAD-related healthcare activities outside of the home. We sought to describe patient time spent obtaining LVAD-related clinical care after index hospital discharge.
Methods: Our single-site sample included LVAD patients discharged after index hospitalization between 5/9/2008-12/31/2019. LVAD-related healthcare encounters (defined based on study team consensus) between discharge date and censor date (earliest of death, heart transplant, LVAD explant, transfer of care, or 12/31/2019) were obtained from electronic health records. Encounters included inpatient admissions, emergency department visits, and LVAD-related ambulatory encounters (clinic visits, blood draws, diagnostic tests and procedures). We quantified the proportion of total number of healthcare encounter days (any day with at least one visit) and total time spent on healthcare encounters for each patient. Comparisons using Kruskal-Wallis tests were conducted for subgroup analyses.
Findings: Sample (n=374) characteristics were: mean age at implant=54.9 years; 78% male; 53% white. Median days from LVAD discharge to censor was 390 (IQR 158-840). Patients had median 86 (IQR 44-161) unique healthcare encounter days, accounting for 23% of their days from LVAD discharge to censor. Patients spent median 587 (IQR 191-1248) hours engaged in healthcare, accounting for 5.3% of their total time from LVAD discharge to censor. HeartWare LVAD was associated with greater % healthcare days, with a trend towards greater % healthcare days in bridge-to-transplant LVAD versus destination therapy (Table).
Conclusions: LVAD patients spent considerable time engaging in healthcare activities outside the home, which may be burdensome or adversely affect quality of life. Our findings may inform strategies to improve efficiency of post-discharge care delivery among LVAD patients.
Methods: Our single-site sample included LVAD patients discharged after index hospitalization between 5/9/2008-12/31/2019. LVAD-related healthcare encounters (defined based on study team consensus) between discharge date and censor date (earliest of death, heart transplant, LVAD explant, transfer of care, or 12/31/2019) were obtained from electronic health records. Encounters included inpatient admissions, emergency department visits, and LVAD-related ambulatory encounters (clinic visits, blood draws, diagnostic tests and procedures). We quantified the proportion of total number of healthcare encounter days (any day with at least one visit) and total time spent on healthcare encounters for each patient. Comparisons using Kruskal-Wallis tests were conducted for subgroup analyses.
Findings: Sample (n=374) characteristics were: mean age at implant=54.9 years; 78% male; 53% white. Median days from LVAD discharge to censor was 390 (IQR 158-840). Patients had median 86 (IQR 44-161) unique healthcare encounter days, accounting for 23% of their days from LVAD discharge to censor. Patients spent median 587 (IQR 191-1248) hours engaged in healthcare, accounting for 5.3% of their total time from LVAD discharge to censor. HeartWare LVAD was associated with greater % healthcare days, with a trend towards greater % healthcare days in bridge-to-transplant LVAD versus destination therapy (Table).
Conclusions: LVAD patients spent considerable time engaging in healthcare activities outside the home, which may be burdensome or adversely affect quality of life. Our findings may inform strategies to improve efficiency of post-discharge care delivery among LVAD patients.
Objective: While implantation of a left ventricular assist device (LVAD) in patients with Stage D heart failure (HF) can prolong survival, this often occurs at the expense of increased time spent in LVAD-related healthcare activities outside of the home. We sought to describe patient time spent obtaining LVAD-related clinical care after index hospital discharge.
Methods: Our single-site sample included LVAD patients discharged after index hospitalization between 5/9/2008-12/31/2019. LVAD-related healthcare encounters (defined based on study team consensus) between discharge date and censor date (earliest of death, heart transplant, LVAD explant, transfer of care, or 12/31/2019) were obtained from electronic health records. Encounters included inpatient admissions, emergency department visits, and LVAD-related ambulatory encounters (clinic visits, blood draws, diagnostic tests and procedures). We quantified the proportion of total number of healthcare encounter days (any day with at least one visit) and total time spent on healthcare encounters for each patient. Comparisons using Kruskal-Wallis tests were conducted for subgroup analyses.
Findings: Sample (n=374) characteristics were: mean age at implant=54.9 years; 78% male; 53% white. Median days from LVAD discharge to censor was 390 (IQR 158-840). Patients had median 86 (IQR 44-161) unique healthcare encounter days, accounting for 23% of their days from LVAD discharge to censor. Patients spent median 587 (IQR 191-1248) hours engaged in healthcare, accounting for 5.3% of their total time from LVAD discharge to censor. HeartWare LVAD was associated with greater % healthcare days, with a trend towards greater % healthcare days in bridge-to-transplant LVAD versus destination therapy (Table).
Conclusions: LVAD patients spent considerable time engaging in healthcare activities outside the home, which may be burdensome or adversely affect quality of life. Our findings may inform strategies to improve efficiency of post-discharge care delivery among LVAD patients.
Methods: Our single-site sample included LVAD patients discharged after index hospitalization between 5/9/2008-12/31/2019. LVAD-related healthcare encounters (defined based on study team consensus) between discharge date and censor date (earliest of death, heart transplant, LVAD explant, transfer of care, or 12/31/2019) were obtained from electronic health records. Encounters included inpatient admissions, emergency department visits, and LVAD-related ambulatory encounters (clinic visits, blood draws, diagnostic tests and procedures). We quantified the proportion of total number of healthcare encounter days (any day with at least one visit) and total time spent on healthcare encounters for each patient. Comparisons using Kruskal-Wallis tests were conducted for subgroup analyses.
Findings: Sample (n=374) characteristics were: mean age at implant=54.9 years; 78% male; 53% white. Median days from LVAD discharge to censor was 390 (IQR 158-840). Patients had median 86 (IQR 44-161) unique healthcare encounter days, accounting for 23% of their days from LVAD discharge to censor. Patients spent median 587 (IQR 191-1248) hours engaged in healthcare, accounting for 5.3% of their total time from LVAD discharge to censor. HeartWare LVAD was associated with greater % healthcare days, with a trend towards greater % healthcare days in bridge-to-transplant LVAD versus destination therapy (Table).
Conclusions: LVAD patients spent considerable time engaging in healthcare activities outside the home, which may be burdensome or adversely affect quality of life. Our findings may inform strategies to improve efficiency of post-discharge care delivery among LVAD patients.
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