Hsiao S1, Chien M2, Teow X2, Chen Y3, Yung Y4
1National Taiwan University Hospital, Division of Physical Therapy, Department of Physical Medicine and Rehabilitation,, Taipei, Taiwan, 2National Taiwan University, Department of Physical Therapy, College of Medicine, Taipei, Taiwan, 3National Taiwan University Hospital, Department of Surgery, Taipei, Taiwan, 4National Taiwan University Hospital, Department of Nursing, Taipei, Taiwan
Background: CentriMag short-term ventricular assist device (VAD) is commonly used for heart failure (HF) patients prior to heart transplantation. Few studies reported the effects of early physical therapy (PT) for these critical patients.
Purpose: This study investigated the effects and outcomes of PT intervention for the VAD patients.
Methods: A total of 62 critical patients (49 male, 13 female) bridged by CentriMag VAD waiting for heart transplantation (mean left ventricular ejection fraction of 22.30±12.79%) in one university hospital in Taiwan, between October 2012 to December 2017, were included in this analysis. We retrospectively reviewed the recordings from electrical medical charts, including the characters of PT programs, modified Chelsea Critical Care Physical Assessment Tool (CPAx) scores, VAD support days, rate of heart transplantation, and mortality.
Results: A total of 41.9% (n = 26) were consulted for early PT interventions (PT group, mean age: 47.5±13.2 years), and the others were not referred to PT (non-PT group, mean age: 44.4±15.6 years). There was no significant difference of basic characteristics between two groups (P>0.05). PT programs included bed activities, sitting, out of bed activities (standing, stepping, and walking). Among the total of 347 treatment sessions (61.2% in intensive care unit, 36.8% in the general ward), there were 238 sessions of out of bed activities (89 sessions of walking programs). No major adverse event occurred during treatment. The CPAx scores of PT group were significantly improved from 10.32±7.56 to 22.80±15.94 (P 0.001) after PT intervention. PT group showed a significantly longer VAD support days than non-PT group (80.74±56.43 vs 27.67±26.33 days, P 0.001). Twenty patients (76.9%) in PT group and 19 patients (52.7%) in non-PT group received heart transplantation (p 0.05). The mortality rates were 38.4% and 50.0% in PT group and non-PT group, respectively (p>0.05).
Conclusion(s): PT interventions were effective to improve functional activity levels and increase the rate of heart transplantation for patients bridged by CentriMag VAD waiting for heart transplantation.
Implications: The referral rate of PT intervention in patients bridged by CentriMag VAD waiting for heart transplantation is still low in Taiwan. Exploring the barriers of limited referral and enhancing multidisciplinary cooperation are essential to improve the total care of patient with VAD.
Keywords: short-term ventricular assist device, physical therapy programs, activity level
Funding acknowledgements: none
Purpose: This study investigated the effects and outcomes of PT intervention for the VAD patients.
Methods: A total of 62 critical patients (49 male, 13 female) bridged by CentriMag VAD waiting for heart transplantation (mean left ventricular ejection fraction of 22.30±12.79%) in one university hospital in Taiwan, between October 2012 to December 2017, were included in this analysis. We retrospectively reviewed the recordings from electrical medical charts, including the characters of PT programs, modified Chelsea Critical Care Physical Assessment Tool (CPAx) scores, VAD support days, rate of heart transplantation, and mortality.
Results: A total of 41.9% (n = 26) were consulted for early PT interventions (PT group, mean age: 47.5±13.2 years), and the others were not referred to PT (non-PT group, mean age: 44.4±15.6 years). There was no significant difference of basic characteristics between two groups (P>0.05). PT programs included bed activities, sitting, out of bed activities (standing, stepping, and walking). Among the total of 347 treatment sessions (61.2% in intensive care unit, 36.8% in the general ward), there were 238 sessions of out of bed activities (89 sessions of walking programs). No major adverse event occurred during treatment. The CPAx scores of PT group were significantly improved from 10.32±7.56 to 22.80±15.94 (P 0.001) after PT intervention. PT group showed a significantly longer VAD support days than non-PT group (80.74±56.43 vs 27.67±26.33 days, P 0.001). Twenty patients (76.9%) in PT group and 19 patients (52.7%) in non-PT group received heart transplantation (p 0.05). The mortality rates were 38.4% and 50.0% in PT group and non-PT group, respectively (p>0.05).
Conclusion(s): PT interventions were effective to improve functional activity levels and increase the rate of heart transplantation for patients bridged by CentriMag VAD waiting for heart transplantation.
Implications: The referral rate of PT intervention in patients bridged by CentriMag VAD waiting for heart transplantation is still low in Taiwan. Exploring the barriers of limited referral and enhancing multidisciplinary cooperation are essential to improve the total care of patient with VAD.
Keywords: short-term ventricular assist device, physical therapy programs, activity level
Funding acknowledgements: none
Topic: Cardiorespiratory; Critical care
Ethics approval required: Yes
Institution: National Taiwan University Hospital
Ethics committee: The Clinical Trial Center of National Taiwan University Hospital
Ethics number: Clinicaltrials.gov identification number: NCT03636815
All authors, affiliations and abstracts have been published as submitted.
