Acute inpatient rehabilitation after left ventricular assist device implantation for congestive heart failure.

Heart failure affects an estimated 5.7 million Americans, and almost 300,000 people die from heart failure in the United States each year [1]. Patients with end-stage heart failure become severely disabled because of dyspnea at rest or with minimal exertion, despite maximal medical therapy. Symptoms that typify heart failure, including shortness of breath and fatigue, also have been shown to be directly related to abnormalities of skeletal muscle [2]. Present available treatment options for these patients include medications, cardiac transplantation, or placement of a left ventricular assist device (LVAD). An LVAD is a mechanical device that is used to partially or completely replace the function of the left ventricle. It may be used either for a short period before cardiac transplantation as a “bridging therapy” or for a long-term period as a “destination therapy” in patients who are too sick to undergo cardiac transplantation. Long-term use of an LVAD can result in a clinically meaningful survival benefit and an improved quality of life [3]. In general, patients who have undergone placement of an LVAD and are transferred to a rehabilitation unit have significant comorbidities and are severely deconditioned. Although LVAD placement improves cardiac hemodynamics, an immediate impact on the functional ability of the patient does not occur because of an associated skeletal myopathy. Rehabilitation for these patients is therefore important and challenging. We present our experience with 3 patients who underwent LVAD implantation as a destination therapy and then were admitted for acute inpatient rehabilitation.