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Ambulatory and Community Mechanical Circulatory Support

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Treatment Chronic Medical Management Î The percutaneous lead should be secured to reduce traction and infection because driveline trauma is the primary cause of driveline infections. Î A strict aseptic protocol should be followed when dressing is changed. Î Patients should receive physical and occupational therapy while hospitalized and referral for cardiac rehabilitation at hospital discharge. Î Treatment with evidence-based heart failure medical therapies could be beneficial in patients on MCS. Î Evidence-based management of comorbid conditions (e.g., hypertension, hyperlipidemia, and diabetes mellitus) is recommended. Table 6. Equipment to Be Transported With Patient Implanting center information Backup controller Backup batteries AC power source Battery charger Well-Being and End of Life Î If psychiatric disability is present after MCS, referral to mental health providers for care, including medication management, counseling, or cognitive behavioral therapy, is recommended. Î Palliative care involvement is indicated during MCS evaluation and for patients with MCS, especially when receiving destination therapy. Î When the prognosis is poor for patients with MCS and their suffering and burden outweigh the benefits, deactivation of the MCS device should be discussed with the patient and family caregivers.

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