Center for Advanced Heart Therapies
Ventricular Assist Device (VAD) and Transplant Evaluation Informed Consent
Welcome to our program. We have developed this document to help you understand the evaluation
process for advanced heart therapies. Please note that every patient situation is different and there may
be exceptions and variations to the process we have outlined. You are being evaluated for VAD as either
Destination Therapy (DT) or Bridge to Transplant (BTT) Therapy. Please ask if you are unsure which type
of therapy is being recommended for you.
Our Team




Advanced Heart Failure/Transplant Cardiologist: Dr. Phillip Habib
Cardiothoracic VAD/Transplant Surgeon: Dr. Brian Bethea
VAD/Transplant Coordinator: Meghan Ciganik, BSN, RN, CHFN
Office Manager/Scheduler/Medical Assistant: Diane Hartel
The evaluation process for advanced heart therapies includes heart transplant and ventricular assist
devices. This involves a step wise approach and includes our multidisciplinary team. The evaluation
period can vary in length from several days to weeks depending on the stage of your heart disease, type
of insurance coverage and other diseases you have.
Phases of Evaluation
Phase 1 testing includes advanced cardiology testing to stage your heart disease and provides financial
education and assessment of your ability to meet the requirements for each type of therapy. The
consults during this part of the evaluation are a mandatory part of the process.
Phase 1 Testing (including but not limited to):












Initial Consult with the Advanced Heart Failure Cardiologist
Financial Consult
VAD/Transplant Coordinator Consult
Chest X-ray
2D Echocardiography
6 Minute Walk Test
Cardiac Viability Study
Cardiopulmonary Exercise Stress Test
Right Heart Catheterization
12 Lead EKG
Heart Failure Questionnaires
Laboratory Testing
Page 1 of 4
Center for Advanced Heart Therapies
Ventricular Assist Device (VAD) and Transplant Evaluation Informed Consent
Financial Consult:
A financial representative of Delray Medical Center will meet with you early in the evaluation process to
help you understand your advanced heart failure benefits related to your insurance coverage. They will
explain your coverage and help you figure out if you can afford any copayments associated with VAD or
transplant. It is very important that you give them the information required so that they can help you.
They will be asking very personal and detailed information about your background and finances. This
information will be kept strictly confidential. There are usually associated copayments for VAD
dressings, cardiac rehabilitation visits and transplant medications in addition to miscellaneous costs such
as transportation to and from clinic. The financial coordinators are skilled at exploring ways to help you
become eligible for these expensive therapies.
VAD/Transplant Coordinator Consult: Our VAD Coordinators are specialized nurses trained in the
management of patients with VADs and heart transplants. They are experienced with VAD and
transplant patients and have extensive knowledge and understanding regarding the requirements
needed for a patient and their support system to be successful with a VAD or transplant. They will
assess you and your caregiver’s ability to learn how to take care of a VAD including equipment,
recognizing and responding to alarms, emergency management and dressing changes. They will help
you understand any restrictions that you may have after VAD or transplant. These nurses will become
your life line to the program should you end up with a VAD or transplant. The education process for VAD
and transplant begins with extensive pre-education with the VAD/Transplant Coordinator. You must be
willing to participate in this process to be considered for advanced therapies.
Phase 2 Testing (including but not limited to):













Cardiothoracic Surgery Consult
Palliative Care Consult
Psychosocial Consult (Social Work)
Physical Therapy Consult
Infectious Disease Consult
Nutrition Consult
Other Consults depending on disease processes present: Psychiatry, Gastroenterology,
Neurology, Nephrology, Endocrine, Dermatology, and Ophthalmology, others as deemed
medically necessary
Laboratory Testing
Colonoscopy within 5 years
Chest CT
Head CT
DEXA Scan
Pulmonary Function Testing
Page 2 of 4
Center for Advanced Heart Therapies
Ventricular Assist Device (VAD) and Transplant Evaluation Informed Consent




Carotid Doppler Studies
ABI Testing
Abdominal Ultrasound
Routine Health Screening: PAP, Prostate, Mammogram, Dental (records need to be sent to our
office)
Palliative Medicine Consult: During your evaluation for advanced heart therapies you will meet with our
Palliative Care team. The purpose of the palliative care consult is to define a “Preparedness Plan”. We
discuss with you and your loved ones your understanding of your disease and create a specific advanced
directive aligning medical treatment options with your goals of care. A conversation regarding expected
benefits and potential burdens will be used to document your goals, values and preferences.
Social Work Consult: Social workers involved with the VAD Program will help patients and their family
understands the procedure and assist with individual and social situations. The social worker will assess
the patient’s strengths, coping abilities, resources, and areas of concern regarding the patient’s ability to
undergo the VAD implant procedure. The social worker uses therapeutic skills and community resources
to help the patient and their family during the evaluation, surgery and recovery. Additionally, the social
worker will conduct an evaluation to ensure the necessary resources are available for the patient during
their recovery. They will meet with the patient’s family and caregivers to provide support and resources.
They help find financial resources and housing resources, and help the patient and their family cope
with the imperative life-changing decision.
Nutrition Consult:
The role of the clinical dietitian is to analyze and assess your current nutritional status. In efforts to do
this, a nutrition assessment will be conducted with you and your caregiver. The nutrition assessment
includes, but is not limited to the following components:






Review height and weight history
Obtain nutrition history (appetite, oral intake, diet followed at home, use of supplements,
medications, food preferences)
Assessment of current nutrition-related lab values
Review of pre and post op diet guidelines
Provide any diet education
Establish a nutrition plan of care
The dietitian will continue to work closely with you, your caregivers and the entire interdisciplinary team
to ensure your nutrition plan of care is followed throughout this process.
Selection Process
After your evaluation is complete your case will be presented to our multidisciplinary VAD and
transplant team for approval, denial or deferment. A VAD/Transplant Coordinator will notify you of the
Page 3 of 4
Center for Advanced Heart Therapies
Ventricular Assist Device (VAD) and Transplant Evaluation Informed Consent
committee decision by standard mail. If you would like information prior to the arrival of your letter feel
free to contact your coordinator. Our selection committee meets on Wednesdays. In addition to our
selection process, we have partnered with a heart transplant center. Your case will also need to be
presented to our affiliated transplant center before a final decision is made. This process may take up to
a week after our selection meeting. If you are deferred for additional testing or an extended observation
period you will be notified with specific instructions on your eligibility requirements. Failure to follow
these requirements will result in the denial of your case.
Special Circumstances for Bridge to Transplant Patients
If you have been accepted for VAD as a Bridge to Transplant (BTT) patient, there are transplant listing
requirements from our affiliated transplant centers that you must meet. We will provide documentation
of these requirements for you with your acceptance letter. If you do not comply with these
requirements you may be removed from the heart transplant waitlist. Please call you coordinator if you
do not understand these requirements.
We will make every effort to accommodate you during the evaluation process. We understand that from
time to time things come up that may prevent you from keeping your appointments. In order to be
successful with a VAD, patients need to commit to following instructions and being compliant with
medications and appointments. Please let us know if you are struggling to make your appointments and
take your medications.
I ___________________________________ have read the information in this document regarding the
evaluation process for Ventricular Assist Device/Transplant. I understand the evaluation process and my
questions have been answered at this time.
_____________________________________________
_________________________
Patient Name
Date
Page 4 of 4