Lai, JV, Muthiah, K, Robson, D, Prichard, R, Walker, R, Pin Lim, C, Wang, LW, Macdonald, PS, Jansz, P & Hayward, CS 2019, 'Impact of Pump Speed on Hemodynamics With Exercise in Continuous Flow Ventricular Assist Device Patients.', ASAIO journal (American Society for Artificial Internal Organs : 1992).View/Download from: Publisher's site
At fixed speed, the spontaneous increase in pump flow accompanying exercise in patients with continuous flow left ventricular assist devices (cfLVADs) is slight in comparison to normal physiologic response, limiting exercise capacity. We systematically exercised 14 patients implanted with an isolated HeartWare HVAD undergoing routine right heart catheterization at baseline and at maximal safe pump speed. In addition to hemodynamics, mixed venous oxygen saturation (SvO2), echocardiography and noninvasive mean arterial pressure, and heart rate were measured. Significantly greater pump flows were achieved with maximum pump speed compared with baseline speed at rest (mean ± standard deviation [SD]: 5.0 ± 0.7 vs. 4.6 ± 0.8 L/min) and peak exercise (6.7 ± 1.0 vs. 5.9 ± 0.9 L/min, p = 0.001). Pulmonary capillary wedge pressure was significantly reduced with maximum pump speed compared to baseline pump speed at rest (10 ± 4 vs. 15 ± 5 mmHg, p < 0.001) and peak exercise (27 ± 8 vs. 30 ± 8 mmHg, p = 0.002). Mixed venous oxygen saturation decreased with exercise (p < 0.001) but was unaffected by changes in pump speed. In summary, although higher pump speeds synergistically augment the increase in pump flow associated with exercise and blunt the exercise-induced rise in left heart filling pressures, elevated filling pressures and markedly diminished SvO2 persist at maximal safe pump speed, suggesting that physiologic flow increases are not met by isolated cfLVADs in the supported failing heart.
Prichard, R, Kershaw, L, Goodall, S, Davidson, P, Newton, P, McNeil, F, Homer, T & Hayward, C 2018, 'Left ventricular device implantation impacts on hospitalisation rates, length of stay and out of hospital time', Heart, Lung and Circulation, vol. 27, no. 6, pp. 708-715.View/Download from: UTS OPUS or Publisher's site
Background Widespread application of left ventricular assist devices (LVADs) in advanced heart failure, is limited by
costs, and access to technical expertise. Hospitalisation drives both cost and inversely, quality of life but
cross institutional and pre-surgical inpatient length of stay data is missing in the Australian literature. We
describe changes in hospitalisation rates, in the year before and after bridge to transplant LVAD therapy and
preceding heart transplant (HTX).
Methods Hospitalisation, Australian refined diagnosis group (ArDRG), and clinical data were assessed for 77/100
consecutive patients listed for heart transplant between July of 2009 and June of 2012. Twenty-five of the
patients required ventricular assist device (VAD) therapy whilst waitlisted. Hospitalisation was defined as
the proportion of ''days at risk' that were spent in hospital and included all public and private admissions
identified in the year before and after VAD implant, or before HTX, in a linked administrative dataset of
admissions across New South Wales.
Results Patients requiring VADs were clinically more unstable and spent proportionally more time in hospital than
pre-HTX patients, (13% (IQR 10-20%) vs 4% (IQR1-10%), p < 0.01). During the index admission, they spent
22 days (IQR 10-33) in hospital before implantation, including 13 days in non-transplant centres (IQR 7-20).
Following implantation, median inpatient stay was 31(IQR 26-70) – including rehabilitation in 8 of the 25
The number of admissions per patientreduced in the year after VAD-implant to two (IQR1-3), from five preimplant
(IQR 3-7) p = 0.002. This was similar to the pre-HTX group's three admissions (IQR1-6), p = 0.33.
Overall hospitalisation decreased in VAD patients beyond the first year from 14% (IQR 10-20%) at 1-year
to 0.5% (IQR 0-10%) at 2-year (p = 0.002). A high percentage of hospitalisation prior to VAD (41%) and HTX
(66%) occurred outside the transplant centre.
Conclusions A high prop...
Jha, SR, McDonagh, J, Prichard, R, Newton, PJ, Hickman, LD, Fung, E, Macdonald, PS & Ferguson, C 2018, '#Frailty: A snapshot Twitter report on frailty knowledge translation.', Australasian Journal on Ageing, vol. 37, no. 4, pp. 309-312.View/Download from: UTS OPUS or Publisher's site
The objectives of this short report are to: (i) explore #Frailty Twitter activity over a six-month period; and (ii) provide a snapshot Twitter content analysis of #Frailty usage.A mixed-method study was conducted to explore Twitter data related to frailty. The primary search term was #Frailty. Objective 1: data were collected using Symplur analytics, including variables for total number of tweets, unique tweeters (users) and total number of impressions. Objective 2: a retrospectively conducted snapshot content analysis of 1500 #Frailty tweets was performed using TweetReach™ .Over a six-month period (1 January 2017-31 June 2017), there was a total of 6545 #Frailty tweets, generating 14.8 million impressions across 3986 participants. Of the 1500 tweets (814 retweets; 202 replies; 484 original tweets), 56% were relevant to clinical frailty. The main contributors ('who') were as follows: the public (29%), researchers (25%), doctors (21%), organisations (18%) and other allied health professionals (7%). Tweet main message intention ('what') was public health/advocacy (41%), social communication (28%), research-based evidence/professional education (24%), professional opinion/case studies (15%) and general news/events (7%).Twitter is increasingly being used to communicate about frailty. It is important that thought leaders contribute to the conversation. There is potential to leverage Twitter to promote and disseminate frailty-related knowledge and research.
Prichard, R, Kershaw, L, Davidson, P, Newton, PJ, Goodall, S & Hayward, C 2018, 'Combining institutional and administrative data to assess hospital costs for patients receiving ventricular assist devices', International Journal of Technology Assessment in Health Care, vol. 34, no. 6, pp. 555-566.View/Download from: UTS OPUS or Publisher's site
Jain, P, Prichard, RA, Connellan, MB, Dhital, KK & Macdonald, P 2017, 'Long distance heart transplantation: a tale of two cities', Internal Medicine Journal, vol. 47, no. 10, pp. 1202-1205.View/Download from: UTS OPUS or Publisher's site
In this 'paired' case report, we describe two heart transplants performed 3 days apart at our centre. Both cases involved very prolonged transportation time of the donor heart. In one case, the donor heart was transported in an ice chest, while in the other case the organ was transported using a normothermic ex vivo perfusion (NEVP) system. The additional retrieval costs incurred by the use NEVP were more than offset by the reduction in subsequent inpatient costs.
Abshire, M, Prichard, R, DiGiacomo, M, Cajita, M & Dennison Himmelfarb, C 2016, 'Adaptation and Coping in patients living with an LVAD: a metasynthesis', Heart and Lung: the journal of acute and critical care, vol. 45, no. 5, pp. 397-405.View/Download from: UTS OPUS or Publisher's site
To synthesize information supporting coping and adaptation of LVAD patients and to identify opportunities for future interventions.
Left Ventricular Assist Device (LVAD) patients demonstrate improvements in quality of life and functional status, but qualitative research has not been meaningfully integrated.
Qualitative meta-synthesis using Lazarus and Folkmans' Transactional Model of stress and coping.
Four distinct stages of adaptation were identified: Pre-LVAD, Implant Hospitalization, Early Home Adaptation and Late Home Adaptation. Each stage includes tasks in physical, psychological and social domains. Two themes emerged: 1) Primary Appraisal: Every stage is a new challenge and 2) Secondary Appraisal: Routines are achievable, emotions are more difficult.
Emotional challenges including fear and anxiety related to life-limiting illness and changed social roles need to be honestly addressed. Individuals living with LVAD achieve a sense of independence, enjoy social interactions and meaningful activities through addressing practical and emotional problems to facilitate coping.
Muthiah, K, Robson, D, Prichard, R, Walker, R, Gupta, S, Keogh, AM, Macdonald, PS, Woodard, J, Kotlyar, E, Dhital, K, Granger, E, Jansz, P, Spratt, P & Hayward, CS 2015, 'Effect of exercise and pump speed modulation on invasive hemodynamics in patients with centrifugal continuous-flow left ventricular assist devices.', The Journal of Heart and Lung Transplantation, vol. 34, no. 4, pp. 522-529.View/Download from: UTS OPUS or Publisher's site
Continuous-flow left ventricular assist devices (CF-LVADs) improve functional capacity in patients with end-stage heart failure. Pump output can be increased by increased pump speed as well as changes in loading conditions.The effect of exercise on invasive hemodynamics was studied in two study protocols. The first examined exercise at fixed pump speed (n = 8) and the second with progressive pump speed increase (n = 11). Patients underwent simultaneous right-heart catheterization, mixed venous saturation, echocardiography and mean arterial pressure monitoring. Before exercise, a ramp speed study was performed in all patients. Patients then undertook symptom-limited supine bicycle exercise.Upward titration of pump speed at rest (by 11.6 ± 8.6% from baseline) increased pump flow from 5.3 ± 1.0 to 6.3 ± 1.0 liters/min (18.9% increase, p < 0.001) and decreased pulmonary capillary wedge pressure (PCWP; 13.6 ± 5.4 to 8.9 ± 4.1 mm Hg, p < 0.001). Exercise increased pump flow to a similar extent as pump speed change alone (to 6.2 ± 1.0 liters/min, p < 0.001), but resulted in increased right- and left-heart filling pressures (right atrial pressure [RAP]: 16.6 ± 7.5 mm Hg, p < 0.001; PCWP 24.8 ± 6.7 mm Hg, p < 0.001). Concomitant pump speed increase with exercise enhanced the pump flow increase (to 7.0 ± 1.4 liters/min, p < 0.001) in Protocol 2, but did not alleviate the increase in pre-load (RAP: 20.5 ± 8.0 mm Hg, p = 0.07; PCWP: 26.8 ± 12.7 mm Hg; p = 0.47). Serum lactate and NT-proBNP levels increased significantly with exercise.Pump flow increases with up-titration of pump speed and with exercise. Although increased pump speed decreases filling pressures at rest, the benefit is not seen with exercise despite concurrent up-titration of pump speed.
Hayward, CS, Salamonsen, R, Keogh, AM, Woodard, J, Ayre, P, Prichard, R, Kotlyar, E, Macdonald, PS, Jansz, P & Spratt, P 2015, 'Impact of left ventricular assist device speed adjustment on exercise tolerance and markers of wall stress', INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS, vol. 38, no. 9, pp. 501-507.View/Download from: Publisher's site
Gupta, S, Woldendorp, K, Muthiah, K, Robson, D, Prichard, R, Macdonald, PS, Keogh, AM, Kotlyar, E, Jabbour, A, Dhital, K, Granger, E, Spratt, P, Jansz, P & Hayward, CS 2014, 'Normalisation of haemodynamics in patients with end-stage heart failure with continuous-flow left ventricular assist device therapy.', Heart, Lung and Circulation, vol. 23, no. 10, pp. 963-969.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: New generation continuous-flow left ventricular assist devices (LVADs) utilise centrifugal pumps. Data concerning their effect on patient haemodynamics, ventricular function and tissue perfusion is limited. We aimed to document these parameters following HeartWare centrifugal continuous-flow LVAD (HVAD) implantation and to assess the impact of post-operative right heart failure (RHF). METHODS: We reviewed 53 consecutive patients (mean age 49.5 ± 14.1 yrs) with HVAD implanted in the left ventricle, at St. Vincent's Hospital, Sydney, between January 2007 and August 2012. Available paired right heart catheterisation (n=35) and echocardiography (n=39) data was reviewed to assess response of invasive haemodynamics and ventricular function to LVAD support. RESULTS: A total of 28 patients (53%) were implanted from interim mechanical circulatory support. Seventeen patients (32%) required short-term post-implant veno-pulmonary artery extracorporeal membrane oxygenation. At 100 ± 61 days post-implant, mean pulmonary artery pressure and mean pulmonary capillary wedge pressure decreased from 38.8 ± 7.7 to 22.9 ± 7.7 mmHg and 28.3 ± 6.4 to 13.4 ± 5.4 mmHg respectively (p<0.001). LV end diastolic diameter decreased from 71.3 ± 12.7 to 61.1 ± 13.7 mm and LV end-systolic diameter from 62.7 ± 12.3 to 53.9 ± 14.4mm (p<0.001). Aortic regurgitation remained trivial. Serum sodium increased from 133.3 ± 5.7 to 139.3 ± 2.8 mmol/L and creatinine decreased from 109.1 ± 42.5 to 74.3 ± 26.2 μmol/L (p<0.001). Across the entire cohort, the six-month survival/transplant rate was significantly lower for RHF patients (72.2%, n=18) compared to those without (96.9%, n=35, p=0.01). CONCLUSIONS: HVAD support improves haemodynamics, LV dimensions and renal function. Following implantation with a centrifugal continuous-flow LVAD, RHF remains a significant risk with a tendency to worse outcomes in the short to medium term.
Prichard, RA, Juul, M, Gazibarich, G, Davidson, PM, Mason, C, Keogh, AM, Macdonald, PS & Hayward, CS 2014, 'Six-minute walk distance predicts VO2 (max) in patients supported with continuous flow left ventricular assist devices', The International Journal of Artificial Organs, vol. 37, no. 7, pp. 539-545.View/Download from: Publisher's site
Hayward, CS, Salamonsen, R, Keogh, AM, Woodard, J, Ayre, P, Prichard, R, Walker, R, Kotlyar, E, Macdonald, PS, Jansz, P & Spratt, P 2011, 'Effect of Alteration in Pump Speed on Pump Output and Left Ventricular Filling with Continuous-Flow Left Ventricular Assist Device', ASAIO JOURNAL, vol. 57, no. 6, pp. 495-500.View/Download from: UTS OPUS or Publisher's site
Prichard, R, Goodall, S, Macdonald, P, Zhao, F-L, Jha, S, Davidson, P, McDonagh, J, Newton, P & Hayward, C 2018, 'Frailty is associated with reduced patient reported quality of life in advanced heart failure patients and clinicians are poor at identifying it', AUSTRALASIAN JOURNAL ON AGEING, WILEY, pp. 49-50.
McDonagh, J, Prichard, R, Jha, SR, Ferguson, C, Macdonald, PS & Newton, PJ 2018, 'Frailty is highly prevalent among inpatients and outpatients with heart failure according to two frailty measurement instruments', AUSTRALASIAN JOURNAL ON AGEING, WILEY, pp. 50-50.
Jha, S, McDonagh, J, Prichard, R, Newton, P, Hickman, L, Macdonald, P & Furguson, C 2018, 'Twitter as a tool for knowledge translation in #frailty research: A snapshot report', AUSTRALASIAN JOURNAL ON AGEING, WILEY, pp. 48-49.
Prichard, R, Hayward, C, Davidson, P & Goodall, S 2018, 'Estimating quality of life in advanced heart failure: can we differentiate excellent expert clinician proxies?', ISPOR Asia Pacific 2018, Tokyo, Japan.
Hernandez Grande, A, Farr-Wharton, B, Simpson, AV, Prichard, R & Reddy, P 2019, 'Recommendations to measure wellbeing in the workplace. A meta-analysis of the wellbeing measures in the public and private sector', International Research Society for Public Management, Wellington, New Zealand.View/Download from: UTS OPUS
Prichard, RR, Newton, PJ, Davidson, PM, Goodall, S, Macdonald, PS, Zhao, FL & Hayward, CS 2017, 'Quality of life in advanced heart failure-disconnect between patients' and clinicians' perceptions, independent of clinician experience.', EUROPEAN JOURNAL OF HEART FAILURE, WILEY, pp. 250-250.
Prichard, RA, Newton, P, Goodall, S, Kershaw, L, Davidson, PM, Homer, T, McNeil, F & Hayward, CS 2016, 'Establishing Institutional Costs in the Year Before and After VAD Implant and Before Heart Transplant', JOURNAL OF HEART AND LUNG TRANSPLANTATION, 36th Annual Meeting and Scientific Sessions of the International-Society-for-Heart-and-Lung-Transplantation (ISHLT), ELSEVIER SCIENCE INC, Washington, DC, pp. S272-S272.View/Download from: Publisher's site
Prichard, R, Hayward, C, Davidson, P, Goodall, S & Newton, P 2016, 'Impact of Left Ventricular Assist Device Implantation on Hospitalisation, and Readmissions Using a Linked Administrative Dataset', Heart Lung and Circulation, The Cardiac Society of Australia and New Zealand, Elsevier, Adelaide, pp. S114-S114.
Lai, JV, Muthiah, K, Prichard, R, Walker, R, Robson, D, Lim, C, Wang, LW, Macdonald, PS, Jansz, P & Hayward, CS 2014, 'Evaluation of Pump Speed Changes with Exercise in Patients with Continuous Flow Ventricular Assist Devices', JOURNAL OF HEART AND LUNG TRANSPLANTATION, 34th Annual Meeting and Scientific Sessions of the International-Society-for-Heart-and-Lung-Transplantation, ELSEVIER SCIENCE INC, San Diego, CA, pp. S155-S156.View/Download from: Publisher's site