Sharing the Care of Mechanical Circulatory Support: Collaborative Efforts of Patients/Caregivers, Shared-Care Sites, and Left Ventricular Assist Device Implanting Centers

Implant center clinical resources are becoming taxed by the growing volume of ambulatory LVAD patients and the rapid growth of this unique population has led to the emergence of MCS shared-care centers. The successful sharing of care with local MCS providers is necessary to allow the continued expansion of this technology to a broader patient population that may otherwise lack adequate access to this life-saving technology. These satellite partnerships facilitate the care of LVAD patients who may be unduly burdened by the distance separating their homes from the implanting centers. This model also allows for a more confident transition from hospital to home. Sharing of care, however, is unlikely to end at the ambulatory level. Because clinical experience grows, common inpatient diagnoses may eventually be comfortably managed by local sites. Implanting centers that develop a solidified partnership with an experienced shared-care center could be anticipated to increasingly promote specialized care such as endoscopy services being delivered locally, thus avoiding unnecessary readmissions. Providing these resources in closer proximity to home would be expected to improve both patient and caregiver's quality of life. Collaborative efforts are necessary to monitor outcomes to ensure that these assumptions are correct. Pivotal to the success of any shared-care relationship is transparent communication that allows identification of potential barriers to care and facilitates the shared objective of improving outcomes. Commitment to a shared-care model by all parties, including patients/caregivers, local providers, and the implanting team, empowers a model of patient-centered, advanced heart failure care focused on quality of life in addition to quality of care.