Cardiac resynchronization therapy-heart failure (CRT-HF) clinic: A novel model of care
Eiran Z Gorodeski1, Christina Magnelli-Reyes2, Laurie Ann Moennich3
1Section of Heart Failure and Cardiac Transplantation, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America.
Insights
Post-implant care for heart failure (HF) patients receiving cardiac resynchronization therapy (CRT) needs a structured approach. A new multidisciplinary clinic model proved feasible, leading to frequent interventions for all patients.
Area of Science:
- Cardiology
- Medical Device Technology
- Health Services Research
Background:
- Current heart failure (HF) and cardiac resynchronization therapy (CRT) guidelines lack specific post-implant care protocols.
- Fragmented care and poor inter-specialty communication hinder optimal outcomes for CRT patients.
- A novel model for post-CRT care is needed for busy clinical settings.
Purpose of the Study:
- To develop and evaluate a new, multidisciplinary model for post-implant care of patients undergoing cardiac resynchronization therapy (CRT).
- To assess the feasibility and impact of a standardized, collaborative post-CRT care visit.
Main Methods:
- A novel, multidisciplinary clinic was designed to standardize post-CRT care.
- Patients received a one-time collaborative visit 6 months post-implant, including cardiac imaging, HF, and electrophysiology specialists.
- Operational feasibility, patient characteristics, interventions, and new diagnoses were recorded.
Main Results:
- 150 patients were seen, with 125 included in the analysis (CRT implanted for standard indications).
- 95% of patients received interventions, with non-responders receiving more (median 3 vs. 2).
- Interventions included device-related (26%), medication-related (74%), and referrals (80%).
Conclusions:
- Multidisciplinary post-implant care for HF patients receiving CRT is feasible.
- This care model leads to frequent medical interventions, irrespective of CRT response status.
Background:
Post-implant care of patients with heart failure (HF) undergoing cardiac resynchronization therapy (CRT) is not addressed in current HF or CRT guidelines and is often fragmented with poor communication between specialties. We sought to develop a new model of post-CRT care which could be implemented in busy clinical settings.
Methods And Results:
We designed a novel, multidisciplinary approach to standardizing post CRT care. All patients receiving a CRT device at the Cleveland Clinic between March 2017 and August 2018 were invited to be seen in the clinic 6 months post implant. A one-time collaborative visit encompassing cardiac imaging, heart failure, and electrophysiology care was performed. We recorded the operational feasibility of the clinic in terms of patient throughput as well as patient characteristics, interventions, and new diagnoses made. Between September 2017 and February 2019, 150 patients were seen in the clinic. Of these, 125 patients had their index CRT implanted for standard indications and were included in the current analysis. Approximately 45 minutes were dedicated for each patient visit. Interventions in care were made in 95% of patients, with CRT non-responders offered a higher number of interventions as compared to responders (median 3 versus 2 interventions). Types of interventions were device-related (26% of population), medication-related (74%), and referral for alternate medical services (80%).
Conclusions:
Multidisciplinary post-implant care of patients with HF receiving CRT devices, regardless of CRT response status, is feasible and results in frequent medical interventions.
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