Current standard of care for ventricular-assist device (VAD) patients is composed of a multidisciplinary team (MDT), which is required in pre-implant and implant hospitalization care but is lacking in post-implant care. Post-implant care is currently centered around the avoidance of complications of VAD support, including cerebrovascular insult (CVA/TIA), gastrointestinal bleeding and infection. Despite major improvements in survival for VAD patients, quality of life and physical functioning measures have not seen significant improvements. This study will include two prospective interventional cohorts and a retrospective control cohort. The first prospective interventional cohort will consist of patients who recently underwent LVAD implantation at Massachusetts General Hospital, and their caregivers. These patients will receive only multidisciplinary team care from the time of their implant. The second prospective interventional cohort will consist of patients who have previously undergone LVAD implantation at Massachusetts General Hospital who are being followed-up with standard-of-care VAD clinic visits, and their caregivers. These patients will receive a hybrid of multidisciplinary team care and standard-of-care visits. The historical control cohort will consist of retrospective data collection on patients who have undergone LVAD implantation in the past and no longer have an LVAD implanted (due to transplant, death, explant, etc.), and will be matched with the prospective interventional patients. The purpose of this study is to characterize the impact of routine MDT care on health-related quality of life, caregiver burnout and functional capacity of outpatient VAD patients, and to determine if implementation of MDT care is associated with a reduction in complications and readmissions in VAD patients at one- and two-years post implant. The investigators hypothesize that the MDT clinic model in addition to standard of care VAD management will positively impact the quality of life and functional status of VAD patients. Subjects who consent to this study will be seen by the MDT providers and complete Cardiopulmonary Exercise Tests (CPET), six-minute-walk-tests, and quality of life questionnaires. The primary caregivers of these subjects will complete a Caregiver Self-Assessment at two timepoints. We anticipate to enroll 20 newly-implanted VAD patients in the pure-MDT arm, 35 pre-existing VAD patients in hybrid-MDT/SOC arm, and 55 primary caregivers.
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Peak VO2 in mL/kg of body weight/min during Cardiopulmonary Exercise Test
Timeframe: Change from pre-implant peak VO2 at 12 months post LVAD implantation
Respiratory Exchange Ratio (RER) in % during Cardiopulmonary Exercise Test
Timeframe: Change from pre-implant RER at 12 months post LVAD implantation
Minute ventilation per carbon dioxide production (VE/VCO2) during Cardiopulmonary Exercise Test
Timeframe: Change from pre-implant VE/VCO2 at 12 months post LVAD implantation
Systolic and diastolic blood pressure in mmHg during Cardiopulmonary Exercise Test
Timeframe: Change from pre-implant blood pressure at 12 months post LVAD implantation
Heart rate in beats per minute during Cardiopulmonary Exercise Test
Timeframe: Change from pre-implant heart rate at 12 months post LVAD implantation
EuroQoL (EQ-5D and EuroVAS) to measure quality of life
Timeframe: Change from pre-implant up to 12 months post LVAD implantation
Kansas City Cardiomyopathy Questionnaire (KCCQ) to measure quality of life
Timeframe: Change from pre-implant up to 12 months post LVAD implantation
Montreal Cognitive Assessment (MoCA) to measure cognitive function
Timeframe: Change from pre-implant up to 12 months post LVAD implantation