Key result
A multidisciplinary post-implant CRT-HF clinic was feasible and resulted in medical interventions for 95% of patients, with CRT non-responders receiving a higher median number of interventions than responders.
Why the study?
Post-implant care for patients with heart failure undergoing CRT is not addressed in current guidelines and is often fragmented with poor communication between specialties.
Does a multidisciplinary CRT-HF clinic model result in actionable medical interventions in patients with heart failure post-CRT implantation?
Observational (n=125)
No
Does a multidisciplinary CRT-HF clinic model result in actionable medical interventions in patients with heart failure post-CRT implantation?
A multidisciplinary post-implant CRT clinic is feasible and leads to frequent medical, device, and referral interventions, especially in CRT non-responders.
Supports feasibility of multidisciplinary post-implant CRT-HF clinics; leaves open outcome benefits in non-responders.
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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Gorodeski et al. (2019) conducted an observational in Heart failure with reduced ejection fraction (HFrEF) post-CRT implantation (n=125). Multidisciplinary CRT-HF clinic visit was evaluated on Proportion of patients receiving one or more medical interventions at the time of clinic visit. A multidisciplinary post-implant CRT-HF clinic was feasible and resulted in medical interventions for 95% of patients, with CRT non-responders receiving a higher median number of interventions than responders.
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