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Geographical variations in healthcare lend us valuable insight in how a complex array of patient and external factors affects disease processes, treatments and outcomes. Differences in patient demographics, genetics, socioeconomic conditions, clinical practice patterns and regulatory policies provide us with empirical data and sometimes natural experiments to answer questions that are either impractical or unethical to answer with randomised control trials. In the realm of advanced heart failure therapies, ventricular assist devices and heart transplantation have been widely adopted therapies in the USA, Canada and Europe. Facing different regulations on device indication (bridge to transplant (BTT) vs destination therapy (DT)), donor heart availability and heart allocation priority systems, how does the experience of left ventricular assist device (LVAD) therapy compare in these different regions? Does longer transplant waiting time significantly impact the effectiveness and complications of BTT LVAD therapy? And more importantly, what lessons can we learn from each other’s experience?
In their Heart paper, Parameshwar et al add to our collective LVAD experience by describing the survival and outcomes of the BTT LVAD population in the UK.1 In the UK, LVAD therapy is funded as a BTT at six approved centres and destination therapy is not funded. All centres are required to submit LVAD therapy data to a national database, adding strength to the comprehensiveness of the study. Utilising this database, the authors analysed all 342 patients who received a HeartMate II or HeartWare HVAD from January 2007 to December 2013 (HeartMate 3 not yet available) and made a few important observations. First, compared with the Interagency Registry for Mechanically …
Contributors Both authors contributed equally.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Disclaimer Dr. Mahr is a consultant for Abbott, Medtronic and Abiomed
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Commissioned; internally peer reviewed.