**5. Discussion**

The shared care to destination therapy model is an example of a new milestone in the advancement of care in the face of a growing heart failure pandemic. This model not only expands access to LVAD care, but also provides patients with social, financial, and satisfaction benefits. Shared care centers allow individuals to reach an advanced heart failure specialist quickly and efficiently by eliminating long distance travel and its associated financial expenses, as well as eliminating the excessive time commitment previously required for routine care. Patients are able to continue to reside in their own communities without making a lifelong commitment to either move where resources are available or spend an excessive amount of time traveling. The physician-to-patient ratios will remain lower enabling the physician-patient relationship to grow stronger over the years, which can improve the physician's ability to deliver personalized care and treat each patient based on their individual needs.

Given the high mortality rates in end stage heart failure and the recent advancements in LVAD technology that now afford a 3 year survival rate comparable to that of heart transplants [12], the demand for LVADs continues to escalate. Just as DHLC implemented the shared care to destination therapy model to eventually become a LVAD implant center, other shared care centers will likely do the same and heart failure cardiologists will be better able to evaluate adHF patients for LVAD candidacy to improve patient outcomes, satisfaction, and quality of life. This involves a multidisciplinary team discussing LVAD selection criteria, action plans, patient support, guideline directed treatment, and comprehensive follow up care.

A successful transition to a destination therapy center consists of a multidisciplinary team made up of an advanced heart failure cardiologist, LVAD surgical director, LVAD medical director, medical critical care director, heart failure nurse practitioners, and two social workers all centered on patient care. Through this period of expansion and development, these multidisciplinary teams are integral to the successful establishment of a shared care center and a LVAD implant center. As former shared care centers transition to destination therapy centers, the network of shared care can then expand outward even more.
