Heart failure: From the ICU to step-down—and home

Heart failure (HF) continues to top the charts as the most costly diagnosis-related group. Ventricular assist devices have become a more common treatment option for patients suffering from end-stage HF. The US Food and Drug Administration approved the use of the Thoratec HeartMate Left Ventricular Assist System as a permanent support in 2003. The system permits most previously bedridden patients to attain a level of stability that allows them to be extubated, ambulatory and nearly independent in care. They no longer need to stay in the intensive care unit (ICU) for months while waiting for a heart transplant, and in some cases, can even go home. Because of this advancement, it is appropriate to transfer these patients to a unit specializing in HF and transplantation. Four phases in the implementation of a successful transfer program are discussed.