Multidisciplinary Care of Patients Receiving Cardiac Resynchronization Therapy Is Associated With Improved Clinical Outcomes

Study Questions:

What is the impact of a “multidisciplinary care” (MC) approach on the clinical outcome in cardiac resynchronization therapy (CRT) patients?

Methods:

The clinical outcome in patients prospectively receiving MC (n = 254) was compared with a control group of patients who received conventional care (CC) (n = 173). The MC group was followed prospectively in an integrated clinic setting by a team of subspecialists from the heart failure (HF), electrophysiology, and echocardiography service at 1, 3, and 6 months post-implant. All patients had echocardiographic-guided optimization at their 1-month visit. The proportional hazards model (adjusting for all covariates) and Kaplan–Meier time to first event curves were compared between the two groups, over a 2-year follow-up. The long-term outcome was measured as a combined endpoint of HF hospitalization, cardiac transplantation, or all-cause mortality.

Results:

The clinical characteristics between the MC and CC groups at baseline were comparable (age, 68 ±13 vs. 69 ±12; New York Heart Association III, 90 vs. 82%; ischemic cardiomyopathy 55 vs. 64%, p = NS, respectively). The event-free survival was significantly higher in the multidisciplinary versus the CC group (p = 0.0015). A significant reduction in clinical events was noted in the MC group versus the CC group (hazard ratio, 0.62; 95% confidence interval, 0.46-0.83; p = 0.001).

Conclusions:

The authors concluded that integrated MC may improve 2-year event-free survival in patients receiving CRT.

Perspective:

This study shows that a multidisciplinary approach is associated with a better clinical outcome in the CRT patients and reduced HF hospitalization and all-cause mortality. There was a 38% relative risk reduction for HF hospitalization, transplant, and/or mortality over a 2-year follow-up in the group receiving MC versus clinical care. As the HF population eligible for device therapy rapidly expands, the need to implement hospital protocols (which simultaneously increases the accountability of practitioners), yield superior cost-effectiveness, and improve clinical outcomes is essential. Although prospective randomized studies are needed to validate the current study findings, an integrated MC model with an electrophysiologist, echocardiographer, and HF specialist makes clinical sense for patients with HF.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Heart Transplant, Interventions and Imaging, Echocardiography/Ultrasound

Keywords: Myocardial Ischemia, Defibrillators, Cost-Benefit Analysis, Follow-Up Studies, Risk Reduction Behavior, New York, Cardiac Resynchronization Therapy, Heart Transplantation, Electrophysiology, Proportional Hazards Models, Cardiac Pacing, Artificial, Radiotherapy, Cardiomyopathies, Heart Failure, Esophageal Neoplasms, Confidence Intervals, Echocardiography


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