Content Outline:
Aim:
To explore the experiences of pre-heart transplant patients using Fitbit as an ambulation-measuring device.
Background:
More than 500,000 people are diagnosed as having heart failure (HF) each year (Lloyd-Jones et al., 2010). A chronic, debilitating disease that often progresses to end-stage quickly when severe ventricular dysfunction leads to alterations in organ perfusion even at rest. Heart transplantation is the definitive treatment for these patients. While waiting for transplantation, HF patients are typically medically managed with Guideline Directed Medical Therapy (GDMT) and they are very prone to less than optimal mobility (Hashim, 2015). Prolonged immobility results in severe widespread deconditioning affecting multiple organs and systems. Prolonged immobilization results in profound loss of muscle strength and endurance of every muscle in the body. Immobilized patients may lose up to 15% of their muscle strength each week and almost half of their normal strength in three to five weeks ((Dittmer, & Teasell, 1993). Complete immobilization will significantly increase a patient’s morbidity and mortality (H’Doubler et al., 2000).Inactivity and prolonged bed rest have also been shown to result in cardiac deconditioning affecting both the central and peripheral cardiovascular systems. Stroke volume has been shown to be reduced by 30% within the first month of bed rest, with an associated increase in resting heart rate, and signs of orthostatic intolerance can develop within 72 hours of inactivity (Winkleman, 2009; Convertino, Bloomfield, & Greenleaf, 1997; Koo, & Fan 2013). Other secondary consequences include increased risk of thromboembolic events, insulin resistance and development of delirium or cognitive impairments and alterations ion sleep patterns (Parry, & Puthucheary, 2015; Winkleman, 2009; Convertino, Bloomfield, & Greenleaf, 1997; Koo, & Fan 2013).
It is imperative that while waiting for a definitive treatment, HF patients need to be mobilized so their muscles will not lose their function. When medical treatment becomes ineffective, invasive pulmonary artery catheter monitoring with concurrent vasopressor support or mechanical support, one which intraortic balloon pump(IABP), is instituted. These treatments further reduce the patient ability to mobilize and walk since they require monitoring wires and cables. Traditional femoral inserted IABP requires complete bedrest.Cardiologists at our hospital have developed a novel percutaneous left axillary-subclavian artery IABP insertion approach to allow patients to mobilize out of bed while awaiting heart transplantation. Percutaneously placed axillary-subclavian intra-aortic balloon pump (IABP) support the patient’s heart while waiting for heart transplantation enabling them to ambulate.Pre-heart transplant patient with Swan-Ganz catheters and one inotropic drip are the second group in this study; Swan-Ganz catheters measures pulmonary artery pressures and inserted via the internal jugular route. These patients are usually more mobile than the first classification. An innovative approach using Fitbit to measure accurately the number of steps patient took during their ambulation process was implemented. Experiences of these patients was explored using descriptive phenomenology to uncover the commonalities of the experience these patient have using Fitbit as an ambulation measurement device.
This presentation examines the patient experiences in their own words using excerpts from recorded interviews and corresponding patient-validated interpretations from the researchers.