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Better outcome at lower costs after implementing a CRT-care pathway: comprehensive evaluation of real-world data
Antonius M W van Stipdonk1, Stijn Schretlen2, Wim Dohmen1
1Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands.
Insights
A new nurse-led cardiac resynchronization therapy (CRT) care pathway significantly reduced heart failure hospitalizations and mortality. This improved patient outcomes while also lowering cardiovascular-related hospital costs, demonstrating cost-effectiveness.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Cardiac resynchronization therapy (CRT) requires complex, multidisciplinary care for heart failure (HF) patients, which is often incomplete due to resource and coordination limitations.
- Current CRT care models face challenges in optimizing patient selection, implantation, and follow-up management.
Purpose of the Study:
- To evaluate the impact of implementing a structured, nurse-led CRT care pathway (CRT-CPW) on clinical outcomes and healthcare costs.
- To assess the effectiveness of checklists and a restructured care model in improving CRT patient management.
Main Methods:
- A retrospective comparison was conducted between patients receiving usual care and those managed under the new CRT-CPW.
- The CRT-CPW involved structured patient selection, implantation, follow-up, and the use of checklists, transitioning from physician-led to nurse-led care.
- Primary outcome was a composite of all-cause mortality and HF hospitalization; hospital costs were also analyzed.
Main Results:
- The CRT-CPW group showed a significant improvement in the primary outcome (25.7% vs. 34.7% at 36 months), with a hazard ratio of 0.56 (P < 0.005).
- Total cardiology-related hospitalization costs were significantly reduced in the CRT-CPW group (€17,698 vs. €19,933, P < 0.001).
- Cost-effectiveness analysis indicated that the CRT-CPW is an economically dominant strategy in 90.7% of bootstrap samples.
Conclusions:
- Implementation of a multidisciplinary, nurse-led CRT care pathway significantly reduces all-cause mortality and HF hospitalizations.
- The novel care pathway leads to reduced cardiovascular-related hospital costs, presenting an economically dominant strategy.
- Structured care pathways with nurse leadership can optimize CRT management and improve patient outcomes effectively.
Aims:
Cardiac resynchronization therapy (CRT) requires intensive, complex, and multidisciplinary care for heart failure (HF) patients. Due to limitations in time, resources, and coordination of care, in current practice, this is often incomplete. We evaluated the effect of the introduction of a CRT-care pathway (CRT-CPW) on clinical outcome and costs.
Methods And Results:
The CRT-CPW focused on structuring CRT patient selection, implantation, and follow-up management. To facilitate and guarantee quality, checklists were introduced. The CRT-CPW was implemented in the Maastricht University Medical Centre in 2014. Physician-led usual care was restructured to a nurse-led care pathway. A retrospective comparison of data from CRT patients receiving usual care (2012-2014, 222 patients) and patients receiving care according to CRT-CPW (2015-2018, 241 patients) was performed. The primary outcome was the composite of all-cause mortality and HF hospitalization. Hospital-related costs of cardiovascular care after CRT implantation were analysed to address cost-effectiveness of the CRT-CPW. Demographics were comparable in the usual care and CRT-CPW groups. Kaplan-Meier estimates of the occurrence of the primary endpoint showed a significant improvement in the CRT-CPW group (25.7% vs. 34.7%, hazard ratio 0.56; confidence interval 0.40-0.78; P < 0.005), at 36 months of follow-up. The total costs for cardiology-related hospitalizations were significantly reduced in the CRT-CPW group [€17 698 (14 192-21 195) vs. 19 933 (16 980-22 991), P < 0.001]. Bootstrap cost-effectiveness analyses showed that implementation of CRT-CPW would be an economically dominant strategy in 90.7% of bootstrap samples.
Conclusions:
The introduction of a novel multidisciplinary, nurse-led care pathway for CRT patients resulted in significant reduction of the combination of all-cause mortality and HF hospitalizations, at reduced cardiovascular-related hospital costs.
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