Download or read book The Clinical and Cost effectiveness of Left Ventricular Assist Devices for End stage Heart Failure written by A. J. Clegg and published by . This book was released on 2005 with total page 148 pages. Available in PDF, EPUB and Kindle. Book excerpt: Objective "to assess the clinical and cost effectiveness of left ventricular assist devices (LVADs) as a bridge to heart transplantation (BTT), as a bridge to myocardial recovery (BTR) or as a long-term chronic support for people with end-stage heart failure (ESHF)." p.iii.
Download or read book The Clinical and Cost effectiveness of Left Ventricular Assist Devices for End stage Heart Failures written by A. J. Clegg and published by . This book was released on 2005 with total page 148 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Left Ventricular Assist Device LVAD as Destination Therapy for Patients with Endstage Heartfailure written by Vigdis Lauvrak and published by . This book was released on 2013 with total page 5 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Norwegian National Council for Priority Setting in the Health Care recommended in 2008 that left ventricular assist device (LVAD) should be offered to patients only for a limited period of time, for example while awaiting heart transplantation. This recommendation may be reconsidered. We have assessed LVAD as destination therapy. In 2008, there was one randomized controlled trial (RCT) comparing first-generation LVAD with optimal medical treatment. A literature search performed in June 2013 provided an RCT from 2009 that compared second-generation LVAD with first-generation LVAD, a few recent prospective case series, registry data and two relevant international cost-effectiveness analyses. Our main conclusions are: 1. Compared with optimal medical therapy LVAD can provide extended life time and improved quality of life for selected patients with end-stage heart failure. The magnitude of the clinical effect is uncertain. 2. There are no studies comparing LVAD with heart transplantation. 3. The most common complications associated with LVAD are bleeding, infections, need for pump replacement, stroke and right ventricular heart failure. These complications are the major cause of death the first two years following pump insertion. 4. The costs of LVAD have been reduced since 2008, but they are still high. International cost-effectiveness analyses are associated with uncertainty. A Norwegian cost-effectiveness analysis has not been performed. 5. Both to offer and not to offer LVAD as destination therapy is ethically challenging.
Download or read book Use of Left Ventricular Assist Devices As Destination Therapy in End Stage Congestive Heart Failure a Systematic Review written by U. S. Department of Veterans Affairs and published by Createspace Independent Pub. This book was released on 2013-05-22 with total page 48 pages. Available in PDF, EPUB and Kindle. Book excerpt: Several common chronic conditions such as atherosclerotic heart disease and hypertension as well as other diseases can result in heart failure, a reduced ability of the heart to pump blood and maintain normal bodily functions. More than 100,000 people in the U.S. with progressive heart failure are refractory to available treatments and have high rates of hospitalization and mortality and a poor quality of life due to limited physical and social activities and psychological stress. Heart transplantation is currently the preferred treatment for end-stage heart failure. Unfortunately, the supply of donor hearts is far less than needed and many patients do not meet the criteria for heart transplantation primarily due to old age and comorbidities such as diabetes with damage to vital organs, pulmonary hypertension, renal insufficiency, malignancies and morbid obesity. Implantable mechanical pumps that assist the circulation of blood by one or both ventricles of the heart have evolved over several decades. Typically blood flows from the native left ventricle of the heart into the surgically implanted assist device and is pumped out into the aorta via an implanted conduit. Currently, long-term implantable left ventricular assist devices require an external source of power and control module. Surgical placement of a left ventricular assist device is increasingly done as a last resort for patients with refractory heart failure who are not eligible for heart transplantation, so called destination therapy. Some patients may improve after they receive a ventricular assist device as destination therapy and become eligible for heart transplantation even though this was not the initial therapeutic goal. A limited number may recover enough heart function to not need a heart transplant or mechanical assist device. Although survival with a newer generation continuous flow ventricular assist device is approaching that of a heart transplant, long-term use of the device by patients who are eligible for a heart transplant is not currently accepted practice. Conversely, many patients that receive a ventricular assist device as a bridge to transplant use the device for increasingly prolonged periods while waiting for a donated heart and some may become ineligible for a heart transplant. The purpose of this report is to review the scientific evidence for use of ventricular assist devices as destination therapy for patients with severe, refractory heart failure who are not eligible for heart transplantation at the time the device is implanted. Although many patients receive the same types of ventricular assist devices as a bridge to heart transplantation or recovery, the characteristics, hence risk profiles, of patients receiving bridge therapy are different from patients selected to receive a device as permanent destination therapy. Furthermore many bridged patients do receive a heart transplant that alters patient outcomes. This review focused on evidence about patient outcomes, patient selection and cost effectiveness of ventricular assist devices specifically intended as destination therapy. The primary goals of destination therapy are to: prolong survival, improve daily function and health-related quality of life, minimize harms including infection, major bleeding episodes, thromboembolic events including strokes and device malfunction or failure especially those that require hospital care. The key questions were: #1. How does use of an FDA-approved, current generation LVAD as destination therapy (i.e., the HeartMate II left ventricular assist device) effect patient outcomes? #2. What patient or site characteristics have been associated with patient benefits or harms when the FDA-approved, current generation LVAD is used as destination therapy? #3. What is the range of cost-effectiveness estimates of using the FDA-approved, current generation LVAD as destination therapy in end-stage heart failure and what explains variation in these estimates?
Download or read book Left Ventricular Assist Devices for Destination Therapy written by and published by . This book was released on 2016 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Objectives Our objectives were to: Determine the clinical effectiveness of LVADs for destination therapy for patients with end-stage heart failure who are ineligible for heart transplantation Estimate the cost-effectiveness of destination-therapy LVAD for patients with end-stage heart failure who are ineligible for heart transplantation and to estimate the potential budget impact for the Ontar [...] What is the potential budget impact over the next 5 years for the Ontario Ministry of Health and Long-Term Care of LVADs for destination therapy in end-stage heart failure patients who are ineligible for heart transplantation? [...] Nevertheless, the included cost-utility studies considered similar comparators, settings/perspectives, and treatment regimens: the study conducted in the Netherlands closely mimicked the Ontario context, and the studies conducted in the United States closely aligned with the treatment regimens and comparators in Canada. [...] February 2016 BUDGET IMPACT ANALYSIS We conducted a budget impact analysis from the perspective of the Ontario Ministry of Health and Long-Term Care to estimate the cost burden of LVAD for destination therapy in 2015 and over the following 4 years (2016 to 2019) under the assumption of limited diffusion. [...] Objective The objective of this analysis was to determine the budget impact for the Ontario Ministry of Health and Long-Term Care of LVADs for destination therapy in end-stage heart failure patients who are ineligible for heart transplantation.
Download or read book Cost Effectiveness in Health and Medicine written by Marthe R. Gold and published by Oxford University Press. This book was released on 1996-07-18 with total page 462 pages. Available in PDF, EPUB and Kindle. Book excerpt: Cost-effectiveness in health and medicine presents a consensus of experts on appropriate methods for standardizing the conduct of CEAs for use in policy arenas. Standardization is of particular importance for CEA, because it allows comparisons of the costs and health outcomes of alternative methods of improving health, such as public health programs and medical technologies. The book provides a detailed discussion of the theoretical background underlying areas of controversy, and uses theory to guide explicit recommendations for study conduct.
Download or read book The Artificial Heart written by Institute of Medicine and published by National Academies Press. This book was released on 1991-02-01 with total page 313 pages. Available in PDF, EPUB and Kindle. Book excerpt: A significant medical event is expected in 1992: the first human use of a fully implantable, long-term cardiac assist device. This timely volume reviews the artificial heart program-and in particular, the National Institutes of Health's major investment-raising important questions. The volume includes: Consideration of the artificial heart versus heart transplantation and other approaches to treating end-stage heart disease, keeping in mind the different outcomes and costs of these treatments. A look at human issues, including the number of people who may require the artificial heart, patient quality of life, and other ethical and societal questions. Examination of how this technology's use can be targeted most appropriately. Attention to achieving access to this technology for all those who can benefit from it. The committee also offers three mechanisms to aid in allocating research and development funds.
Download or read book Ventricular Assist Devices in Advanced Stage Heart Failure written by Shunei Kyo and published by Springer Science & Business Media. This book was released on 2013-11-25 with total page 154 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book focuses on how ventricular assist devices (VADs) can help provide destination therapy for patients with terminal heart failure, one of the most serious diseases in the world today because of the tremendous number of patients, the high mortality rate, and the cost of care. One means of providing cardiological support for patients suffering from heart failure is with VADs, and more than 10,000 patients worldwide have now been implanted with these devices. Half of them already have lived more than one year, and 2,000 patients more than two years, after surgery. This improved survival means that we have reached a point where VADs can be used for destination therapy, not just for bridge-to-recovery or bridge-to-transplant. In view of the increasing number of patients with advanced-stage heart failure and the availability and longevity of transplanted hearts, VADs can solve many problems. In addition to providing information about the devices themselves, this book includes vital guidelines on long-term management and support of VAD-implanted patients’ everyday lives.
Download or read book Left Ventricular Assist Devices An Issue of Cardiology Clinics written by John A. Elefteriades and published by Elsevier Health Sciences. This book was released on 2011-11-28 with total page 188 pages. Available in PDF, EPUB and Kindle. Book excerpt: A left ventricular assist device (LVAD) is a surgically implanted pump that helps the left ventricle pump blood to the rest of the body. The purpose of this issue is to let cardiologists know about the latest devices, their complications, and the clinical situations in which they are most beneficial.
Download or read book Use of Left Ventricular Assist Devices as Destination Therapy in End stage Congestive Heart Failure written by Thomas S. Rector and published by . This book was released on 2012 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Heart failure is defined as reduced ability of the heart to pump blood and maintain normal bodily function. Heart transplantation is currently the preferred treatment for end-stage heart failure but the supply of donor hearts is insufficient to meet the need and many patients are not eligible for transplantation due to age or comorbid conditions. Implantable mechanical pumps can assist the circulation of blood by the ventricles. Left ventricular assist devices (LVADs) have been approved by the U.S. Food and Drug Administration (FDA) for use in patients awaiting transplant (a bridge to transplant) and as a last resort in patients with refractory heart failure who are not eligible for a heart transplant (destination therapy). In January 2010, the first newer generation, rotary continuous flow ventricular assist device (HeartMate II) was approved by the FDA for destination therapy. Eligibility criteria are essentially the same as those used to select patients for the pivotal clinical trial that included patients with shortness of breath and/or fatigue at rest or during minimal exertion despite treatment with optimal therapy for heart failure associated with a low ejection fraction (
Download or read book Acoustic and afterload evaluation of left ventricular assist devices written by Per Sundbom and published by Linköping University Electronic Press. This book was released on 2019-11-12 with total page 86 pages. Available in PDF, EPUB and Kindle. Book excerpt: Background: Heart Failure is a serious condition with consequences not only for the individual patient but also for the society with a 5-year mortality rate of 45-60%, and a substantial economic burden. The estimated prevalence in Sweden is 2.2% and the age adjusted prevalence increases with higher age. The fundamental treatment for heart failure is pharmaceutical in combination with life-style changes, and physiotherapy. For patients with advanced heart failure, the use of long-term circulatory support can be an option as a bridge to transplantation, or as destination therapy. However, this treatment entails a risk of multiple adverse events. The incidence of pump thrombosis increased as a clinical problem in 2012 and the need for diagnostic methods were desired. The aim of this thesis was to develop and to evaluate the use of a mock loop circuit to study the acoustics of left ventricular assist devices, to evaluate different recording devices and to study the effect of afterload on pump function. Methods: Two different mock loops, with the possibility to insert artificial thrombus and to adjust preload and afterload were created to facilitate recording of the left ventricular assist devices. An iPhone/iPodTM was used as recording device since remote monitoring is desirable. The sounds from HeartMate IITM during different conditions were studied. The iPhone/iPod was evaluated in comparison to dedicated recording equipment, and the mock loop recordings to clinical situation. The sound from HeartMate 3TM was studied, compared between in vivo and in vitro recordings, and the use of an electronic stethoscope was evaluated. The impact of afterload on left ventricular assist devices was studied in a mock loop circuit with different changes in preload and afterload. Results: Mock loop circuit is a promising method to safely change the surrounding conditions as the pump is working. The sound from both HeartMate IITM and HeartMate 3TM can be recorded and analyzed in frequency and time domain. When inserting artificial thrombus in a HeartMate IITM the frequency spectrum is altered. The use of dedicated recording devices is superior to both electronic stethoscope and iPhone/iPodTM, but these handheld devices can be used in clinical settings. The recordings from mock loop circuit and patients appear similar for both HeartMate IITM and HeartMate 3TM. The flow of the devices is affected by the afterload. The HeartMate 3TM is more resistant to increased clot analogs within the pump. For both pumps, best efficacy is seen for clean circuits. The flow rate from the monitor might be misleading since the measured flow rate and the flow rate from monitor can differ due to surrounding conditions. The estimated flow might be adjusted by fitting a parabolic curve. Conclusion: The use of mock loop circuit to study both flow and sound under different conditions is valid. It is possible to record and study the sound from both HeartMate IITM and HeartMate 3TM. The sound holds information of pump function and appears similar in vivo and in vitro. All recording devices can be used, but dedicated equipment is superior to the more handheld devices, although these might have a function as a screening device. The flow measurement on the monitor might not be valid and optimization of fluid status and afterload can further increase pump efficiency.
Download or read book Clinical Effectiveness and Cost effectiveness of Second and Third generation Left Ventricular Assist Devices as Either Bridge to Transplant Or Alternative to Transplant for Adults Eligible for Heart written by and published by . This book was released on 2013 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Left Ventricular Assist Devices for Destination Therapy written by Health Quality Ontario and published by . This book was released on 2016 with total page 60 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Disease Control Priorities Third Edition Volume 5 written by Dorairaj Prabhakaran and published by World Bank Publications. This book was released on 2017-11-17 with total page 948 pages. Available in PDF, EPUB and Kindle. Book excerpt: Cardiovascular, respiratory, and related conditions cause more than 40 percent of all deaths globally, and their substantial burden is rising, particularly in low- and middle-income countries (LMICs). Their burden extends well beyond health effects to include significant economic and societal consequences. Most of these conditions are related, share risk factors, and have common control measures at the clinical, population, and policy levels. Lives can be extended and improved when these diseases are prevented, detected, and managed. This volume summarizes current knowledge and presents evidence-based interventions that are effective, cost-effective, and scalable in LMICs.
Download or read book The Artificial Heart written by Committee to Evaluate the Artificial Heart Program of the National Heart, Lung, and Blood Institute and published by . This book was released on 1991 with total page 320 pages. Available in PDF, EPUB and Kindle. Book excerpt: A significant medical event is expected in 1992: the first human use of a fully implantable, long-term cardiac assist device. This timely volume reviews the artificial heart program-and in particular, the National Institutes of Health's major investment-raising important questions. The volume includes: Consideration of the artificial heart versus heart transplantation and other approaches to treating end-stage heart disease, keeping in mind the different outcomes and costs of these treatments. A look at human issues, including the number of people who may require the artificial heart, patient quality of life, and other ethical and societal questions. Examination of how this technology's use can be targeted most appropriately. Attention to achieving access to this technology for all those who can benefit from it. The committee also offers three mechanisms to aid in allocating research and development funds.
Download or read book Recent Advances in the Field of Ventricular Assist Devices written by Kazuo Komamura and published by BoD – Books on Demand. This book was released on 2013-05-08 with total page 106 pages. Available in PDF, EPUB and Kindle. Book excerpt: Recent Advances in the Field of Ventricular Assist Devices covers recent various advances and developments relating to ventricular assist devices and their diverse complications. Firstly, we overview recent technical advances as well as current indications, clinical outcomes, and countermeasures against complications, and furthermore, the latest techniques to identify clinical effectiveness at the patient’s bedside. Secondly, we elucidate the current status of countermeasures against gastrointestinal bleeding, and current research on allosensitization during the usage of continuous flow pump. Finally, we explore the possibility of a new adjunct therapy in combination with ventricular assist devices. We hope that this book will provide valuable and up-to-date information on research and clinical use of ventricular assist devices.
Download or read book Acute Heart Failure written by Alexandre Mebazaa and published by Springer Science & Business Media. This book was released on 2009-12-24 with total page 922 pages. Available in PDF, EPUB and Kindle. Book excerpt: For many years, there has been a great deal of work done on chronic congestive heart failure while acute heart failure has been considered a difficult to handle and hopeless syndrome. However, in recent years acute heart failure has become a growing area of study and this is the first book to cover extensively the diagnosis and management of this complex condition. The book reflects the considerable amounts of new data reported and many new concepts which have been proposed in the last 3-4 years looking at the epidemiology, diagnostic and treatment of acute heart failure.
