Treatment paths and resources used for patients with a left ventricular assist device: an Italian survey

Abstract

Background The number of people with end-stage Heart Failure implanted with a Left Ventricular Assist Device (LVAD) is constantly increasing, demanding hospitals to develop new and specific treatment paths. No previous studies described services and treatments available for these patients at national level. Knowing how hospitals organize their resources in order to meet patients’ need would be useful to standardize and improve care offered to this population. Purpose To investigate how Italian hospitals that are reference centers for people with LVAD organize treatment paths and resources for these patients. Methods A cross-sectional observational study was conducted. A survey including questions about all the relevant aspects of treatment paths for people with LVAD was created and validated by 4 LVAD experts (2 nurses and 2 physicians) from 2 different hospitals. The survey was then administered to the 22 (> 95%) of the Italian hospitals that are reference centers for people with LVAD. Results Results show a picture of how treatment paths and resources for people with LVAD are organized in Italy nowadays. Nurses play a pivotal role in the multi-professional team that takes care of these patients, being often acknowledged as LVAD Coordinator (case-manager) and being involved in crucial activities such as health education, monitoring of health conditions before and after dismission, and improving patients’ empowerment. Health education is recognized as an essential activity, but many hospitals still struggle to organize it according to patients’ needs and not organizational ones. Palliative care, even if recognized by the most recent guidelines as a crucial element of treatment options in people with LVAD, is a need that remains often unmet. Conclusion The growing number of people with LVAD requires an effort for re-organizing resources and treatment paths for them. There is a great need for integrating palliative care in the several treatment options for these patients. Nurses play a pivotal role in all stages of the treatment paths, and should be provided with specific education, as the whole multi-professional team.