1. Managing the LVAD patient in Cardiac Rehabilitation
2012 NWCVPR Annual Conference
MultiCare Health System
Tacoma General Hospital
Cardiac Health and Rehabilitation Program

2. 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

3. Program Overview Intake Interview – RN 1:1 Exercise Evaluation – CES
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
ECG monitoring – typically PACED
Case management – risk factor /lifestyle modification
Exercise tolerance – heart failure patient
No blood pressure readings

4. 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)

5. 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

6. 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

7. 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

8. Emergency Procedures – Heartmate II
RED HEART
DEVICE IS RUNNING
Call CT Surgeon on call
Page VAD Coordinator
Treat Arrythmia
Fluid Resuscitate
DEVICE HAS STOPPED
CHECK CONNECTIONS
DO NOT CONNECT to Power Base Unit
Replace Controller at direction of Surgeon or VAD Coordinator
Leave Device Alone
Assess/Treat Patient (Volume, Rhythm, HTN
Obstruction: inflow/outflow)
IF TIGHT

9. Questions…