ABCs of Stroke Prevention Improve Outcomes for Children Using VADs

Published December 2020 | Circulation: Cardiovascular Quality and Outcomes

More than 9,500 children are admitted to U.S. hospitals each year to treat heart failure. While pediatric ventricular assist devices (VADs) improve outcomes for many, up to 29% of patients still experience strokes as a dangerous complication of device implantation.

In 2017, Cincinnati Children’s convened a group of cardiac care experts and families to form the ACTION (Advanced Cardiac Therapies Improving Outcomes Network) learning network to improve heart failure outcomes. In this study, the group dove into the factors driving stroke complications.

Before the project, anticoagulant use with paracorporeal devices was inconsistent, including use of bivalirudin, a drug with a favorable profile for use in children. But adoption of the “ABCs of Stroke Prevention” protocol (anticoagulation management, blood pressure management, and communication) resulted in sharp increases in use of the drug.

The project also improved consistency of blood pressure assessment and control as care teams worked to implement a stroke prevention checklist.

For the 86 patients involved in the updated protocol, stroke incidence was reduced to 14%. Since the work began, the number of heart centers adopting the ABCs of Stroke Prevention has grown from 20 to 44.

The stroke prevention report was compiled primarily by first author Chet Villa, MD, and senior author Angela Lorts, MD, MBA. The 30+ ACTION investigators listed as co-authors also included Cincinnati Children’s experts David L.S. Morales, MD, Farhan Zafar, MBBS, Paige Krack, MBA, Lauren Smyth, MHA, and Katrina Fields, BSN, RN.

“Given the combination of low patient volumes and high complexity for this form of care, forming the ACTION network was vital to achieving collaborations with a broad range of stakeholders, including patients, families, industry regulators and clinicians of varying backgrounds such as physicians, surgeons, nurses, and care coordinators,” Lorts says.

Frequency of Strokes and Strokes per Support Day Stratified by Device Type Among Patients in the ACTION Outcome Registry Database

ACTION: Advanced Cardiac Therapies Improving Outcomes Network; TAH: total artificial heart