Creating Global Care: An International Shared Care Experience

Purpose International shared care can provide access to advanced options for patients in various parts of the world with end stage heart failure who are deemed high risk surgical candidates. We sought to describe the process utilized to provide successful, co-managed, culturally sensitive international shared care. Methods A retrospective analysis was performed to evaluate outcomes and hemocompatability related adverse event (HRAE) rates of a successful international shared care model between a large, academic medical center in the United States (US) and two shared care hospitals located in two countries in the Middle East. Results After training at the implant site is completed by the shared care team, a partnership can continue remotely. Ongoing communication with the International office ensures a streamlined process for referrals, successful transition for a patient to return home, co-management of adverse events, and continued education for patients, families, and shared care providers. This partnership resulted in 109 patient referrals since 2016. 7 patients were discharged from the hospital on centrifugal flow ventricular assist devices (HM3 n=3 or HVAD n=4) with 100% survival at 6 months and 85% of patients returned home (n=6). Since discharge, there has been 100% freedom from stroke or thrombosis related adverse events compared to IMACs 69.1% at 6 months for patients on isolated centrifugal flow device. Additional adverse events include 1 driveline infection (14%) and 1 outpatient GI bleed (14%). Conclusion International shared care provides access to advanced heart failure therapies in other countries and co-management facilitates improved patient outcomes with lower HRAE rates. Quality VAD care can be shared, regardless of language or location. Further application of this model in other countries should be further employed and evaluated.