Author + information
- Marjorie L. King, MD⁎ (, )
- Randal Thomas, MD and
- Ileana Pina, MD
- ↵⁎Cardiac Services, Helen Hayes Hospital, Route 9W, West Haverstraw, New York 10993
The review by Wilson et al. (1) outlines several important principles in the outpatient management of patients with ventricular assist devices (VADs), including the provision of physical exercise, nutrition, and routine self-care, as well as the coordination of effective communication among heart failure (HF) specialists, primary care providers, and first responders. The authors also recognize that adequate cardiac rehabilitation (CR) plays a central role in a patient's recovery yet lamented that this is often difficult to carry out for patients with VADs in a typical community setting, because community rehab programs might be uncomfortable with enrolling these patients.
As fellows of the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), we encourage professionals who work in HF teams to reach out to AACVPR certified programs in their communities (2) to develop collaborative relationships to develop safe, effective CR environments. We also welcome the opportunity to use the information from this article to develop educational programs for our members to help them serve these patients.
Cardiac rehabilitation is an excellent environment to reinforce self-management; provide emotional support; and increase exercise tolerance, functional capacity, and quality of life (3). Patients who receive VADs have been unable to perform much activity and have become debilitated by the inherent disease process and prolonged bed rest. This group would particularly benefit from CR to restore them to an acceptable physical function and provide education and counseling that would complement the education afforded by the HF team.
Although many insurance carriers do not currently cover monitored (Phase 2) CR for patients with HF, efforts are ongoing to encourage such coverage. In the meantime, patients with HF are covered by most insurance plans for Phase 2 CR if they have a qualifying diagnosis (recent myocardial infarction, coronary artery bypass surgery, percutaneous coronary intervention, heart valve surgery, or heart transplantation). Alternatively, they can participate in a self-pay maintenance CR program (Phase 4, approximate cost of $50 to $60/month), if deemed appropriate by their medical care provider and by the CR team.
We agree with Wilson et al. (1) that a strong collaborative relationship between HF and CR teams is essential to provide optimal care for patients with VADs and encourage cardiovascular specialists and professional associations devoted to improving care for patients with HF to join with AACVPR to help make this happen for our patients.
- American College of Cardiology Foundation
- Wilson S.R.,
- Givertz M.M.,
- Stewart G.C.,
- Mudge G.H.
- AACVPR Program Directory
- Balady G.J.,
- Williams M.A.,
- Ades P.A.,
- et al.