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Frequently Asked Questions

As a managing physician, this list of frequently-asked questions can provide a starting point for discussing MCS therapy options with your advanced heart failure patients.

It seems like I'm getting sicker. Do I have other options?

  • A range of interventions can be initiated to improve the advanced heart failure patient's condition.
  • Only a physician can determine whether a lifestyle or medication adjustment is warranted, or if the time has come to refer the patient for a ventricular assist device (VAD)/cardiac transplantation evaluation. However, a patient who has exhibited a worsening of symptoms should receive an introduction to options that may be appropriate in the future.

I've never heard of a ventricular assist device. Is it new?

  • Many patients will not know that VADs have been used in advanced heart failure patients for well over a decade. They may have concerns that VADs are experimental and unproven. Ventricular assist devices have been proven as both bridge-to-transplantation and long-term therapy, improving survival and quality of life for advanced heart failure patients. Newer devices are smaller, quieter and more durable, providing better quality of life. This may be a good time to share the HeartMate II website. Request these patient education materials.

I don't feel that bad. Do I really need this?

  • Discuss the ways that the patient may currently be compensating for their worsening condition, such as limiting their activities, avoiding certain household chores, or sleeping in a sitting position. Help them understand that they may have begun to lose sight of the fact that they are not really living with good quality of life, and may have begun to deceive themselves into thinking their condition is "not that bad."
  • When clinically indicated, an adjustment or change of medical strategy can provide patients with a significant improvement in their NYHA functional class and improvement in quality of life.
  • Though patients should not be bogged down with selection criteria, they should understand that you are referring them for an evaluation at a time when you hope to maximize their potential for a good outcome and improved quality of life.

What is the benefit of having a ventricular assist device?

  • It is important to reassure patients that, while VAD implantation carries some risks, for many the potential benefits far outweigh them. Family members, especially the primary caregiver, may express concerns about putting their loved one through "more." Whether the patient is awaiting transplantation or being considered for long-term VAD therapy, a VAD can give patients real hope of extending and improving their lives.
  • A separate conversation with family members may allow them to ask you questions that they might avoid in front of the patient. Help them understand that post-implantation, the patient will be cared for in the hospital; though there will be a device to manage once the patient returns home, the impact on their lifestyle will be largely positive.

If you refer me to someone else, who will that be? I am comfortable with you—why can't you be my doctor for this?

  • Help patients understand that you will remain their physician, and in the event that they receive a VAD or transplant, they can return to your care for follow-up visits. Managing physicians routinely provide all post-operative patient care that is not device-related once patients are discharged from the hospital.
  • Explain that you are referring them to a leading center that offers advanced technologies to provide them with very specialized treatment options, and that most hospitals cannot provide MCS and cardiac transplantation procedures. Printed materials about the center may also be helpful. If patients understand that you're referring them because you believe this is the best option for their care at the present time, you will help them feel more comfortable about the process. Most importantly, the patient can take comfort in knowing that there is solid communication and an atmosphere of collaboration among all members of the healthcare team.
  • The following are some lay descriptions of specialists that a patient may see at the tertiary care center:
    • Heart failure cardiologist: Heart failure specialists with similar background to yours who have chosen to focus their careers on therapies for advanced heart failure. Some have helped create the current treatment guidelines for advanced heart failure. They often practice at academic medical centers, and may have access to procedures, devices, and medicines that are being studied in clinical trials and are funded through large grants.
    • Cardiac surgeon: These surgeons have completed training in surgery of the heart. Many of these surgeons focus their practices specifically on surgeries that help to restore or improve the pumping function of a diseased heart, or to replace the heart altogether with a transplant.
    • VAD coordinator: A specially-trained staff member, usually a nurse, at the implanting center who helps coordinate the hospital team of physicians, nutritionists, therapists, social workers and nurses who work together to ensure the best care for patients before, during and after VAD implantation.

What part of this is covered by insurance?

  • Today, people of all ages and socioeconomic groups comprise the spectrum of advanced heart failure patients benefiting from mechanical circulatory support therapy.
  • New reimbursement codes established by the Centers for Medicare and Medicaid Services (CMS) have established appropriate payment levels for MCS therapy, encouraging more medical centers to offer it to patients and providing more complete insurance coverage for expenses. Since policies may vary, the patient's insurance provider can supply more specific information.

What will my life be like with a ventricular assist device?

  • Reassure patients that the improved pumping function they will most likely experience after VAD implantation will enable them to return to their daily lives with very few restrictions on activity.
  • With the restoration of blood flow, VAD patients reclaim their lifestyles, enabling them to shop, garden, and visit friends. The tertiary care center will prepare them for the steps that must be taken when traveling, but many VAD patients are excited with their post-implant ability to travel and to see friends and loved ones.
  • Because the equipment associated with VADs is outside the body, patients must avoid water immersion, so swimming, soaking in the tub, and fly fishing are examples of activities not permitted. However, patients can shower by using a shower kit with the VAD. In addition, patients should not engage in contact sports, but enjoying the backyard, walking the dog, and playing golf are all in the realm of normal and expected!
  • Patients should not become pregnant
  • The Living with the HeartMate video series is recommended for patients with related concerns.

Request Education Materials

Can I meet a patient who has a ventricular assist device?

  • There are many support groups available for patients and caregivers. Patients may also be able to meet a VAD patient through the tertiary care center where you refer them.
  • Other valuable resources are the VAD patient stories on www.HeartMateII.com and the living with the HeartMate II video series.
  • It is also helpful if you can share any experience that you have had with past VAD recipients.

What happens if the ventricular assist device fails? After all, it is a machine.

  • VADs are designed to function reliably for long periods of time. Before leaving the hospital, the patient and family will be trained in the proper function and management of the device. A staff member (likely the VAD coordinator) will thoroughly discuss device operation and its accessories.
  • The device will also be checked at follow-up visits. In the event of a problem, the device will alert the patient so that immediate action can be taken.

Next: Request Education Materials