Management of Heart Failure in Left Ventricular Assist Device (LVAD) Patients Utilizing an Outpatient Diuresis Clinic

K. Freed, K. Cuomo, A. Hubbard, S. Riley, K. Menzel, K. Sharma, R. Florido, S. Hsu, A. Kilic, C. Choi, M. Aslam, P. Umapathi, R. Fioretti, N. Klemans, N. Gilotra

Research output: Contribution to journalArticle

Abstract

PURPOSE: Left ventricular assist device (LVAD) implantation and survival is increasing. With patients living longer on device support, LVAD-related healthcare costs and hospitalizations, including those for volume overload, are on the rise as well. The Johns Hopkins Heart Failure Bridge Clinic (HFBC), a HF-trained Nurse Practitioner (NP) led clinic with ability to administer outpatient intravenous (IV) diuretics, has resulted in significant reductions in HF readmission rates. We developed a protocol for LVAD patient assessment and management via the HFBC, and describe our initial experience regarding the role and efficacy of this unique program in outpatient management of HF in LVAD patients. METHODS: LVAD patients were evaluated by an LVAD provider and subsequently referred to the diuresis clinic for volume overload thought not to be related to an LVAD issue. If seen in the diuresis clinic, patients then had repeat evaluation with the LVAD/HF team within one week. Baseline characteristics and HF outcomes were assessed. RESULTS: Nineteen LVAD patients were seen in the diuresis clinic a total of 65 times. IV furosemide was administered 31 times to 13 patients (mean dose 80 ± 23.5 mg). Urine output during first in clinic void after IV diuretic was 125 ± 53 mL. At 30 of 65 (46%) visits, oral diuretic dose was uptitrated. Potassium was given at 18 of the 65 (27.7%) visits. There were no significant changes in blood pressure, renal function, or electrolytes post diuresis. Only 1 of 65 patient visits resulted in direct hospital admission (hyponatremia). All other visits discharged to home in improved/stable condition and avoidance of hospitalization for heart failure. During follow up, only 6 of 19 patients were hospitalized for a primary diagnosis of volume overload. CONCLUSION: We describe successful implementation of an outpatient IV diuresis protocol for treatment of HF in LVAD patients. The strategy has major implications in reducing LVAD-related HF hospitalizations and healthcare utilization.

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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