Patient-specific predictors of physical recovery after LVAD implantation

Abstract

Background Improvement of physical capacity is one of the primary goals after Left Ventricular Assistant Device (LVAD) placement in heart failure patients. Although LVAD placement is effective at regaining physical capacity and quality of life in some patients, others do not benefit. Identifying factors related to a lack of physical improvement at discharge may help personalize care after implantation. Aim This study aims to determine if physical fitness and patient characteristics can predict a lack of physical improvement in LVAD patients measured with the six-minute walk test (6MWT). Methods Data of patients with an LVAD implanted at the University Medical Center Utrecht between November 2014 and January 2023 were collected. The difference in walking distance on 6MWT in the short term (three months) and long term (first year) after implantation was calculated. Patients with an improvement in walking distance of less than 45 meters in the first three months were considered to have a lack of physical improvement. Patients with a walking distance more than 45 meters were considered improvers. Odds ratios were calculated using logistic regression. Results The total cohort consisted of 214 patients (mean age 52.4). There were 49 patients with a lack of physical improvement (mean walking difference: -54,9 ±26.6), and 165 improvers (mean walking difference: 195.2 ±15.7). The physical capacity of the total cohort increased significantly in the short- term (138.0 ±33.3, p: < 0.001), and in the long-term (188.7 ±39.9, p: < 0.001). Walking distance > 300 meters at discharge is a significant predictor (OR 5.701, 95% C.I, 2.044 – 15.899) for a lack of physical improvement. Conclusion and key findings Patients walking more than 300 meters on a 6MWT at discharge are more likely to have a lack of physical improvement after LVAD implantation. Physical capacity increases after LVAD implantation, these results give more certainty to patients relying on an LVAD to be alive. To predict physical improvement personalized care is needed to identify those with a lack of physical improvement. It seems to be important to repeatedly monitor the physical capacity of LVAD patients. Keywords: Heart-Assist Devices, LVAD, Cardiac Rehabilitation, Functional Capacity, prognosis.