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Multidisciplinary care of patients receiving cardiac resynchronization therapy is associated with improved clinical outcomes

Robert K. Altman , Kimberly A. Parks , Christopher L. Schlett , Mary Orencole , Mi-Young Park , Quynh A. Truong , Peerawut Deeprasertkul , Stephanie A. Moore , Conor D. Barrett , Gregory D. Lewis , Saumya Das , Gaurav A. Upadhyay , E. Kevin Heist , Michael H. Picard , Jagmeet P. Singh
DOI: http://dx.doi.org/10.1093/eurheartj/ehs107 First published online: 21 May 2012

Abstract

Aims Although cardiac resynchronization therapy (CRT) reduces morbidity and mortality in patients with heart failure, a significant minority of patients do not respond adequately to this therapy. The objective of this study was to examine the impact of a ‘multidisciplinary care’ (MC) approach on the clinical outcome in CRT patients.

Methods and results 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, 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 heart failure hospitalization, cardiac transplantation, or all-cause mortality. The clinical characteristics between the MC and CC groups at baseline were comparable (age, 68 ± 13 vs. 69 ± 12; NYHA III, 90 vs. 82%; ischaemic cardiomyopathy 55 vs. 64%, P = NS, respectively). The event-free survival was significantly higher in the multidisciplinary vs. the CC group (P = 0.0015). A significant reduction in clinical events was noted in the MC group vs. the CC group (hazard ratio: 0.62, 95% CI: 0.46–0.83, P = 0.001).

Conclusion Integrated MC may improve 2-year event-free survival in patients receiving cardiac resynchronization therapy. Prospective randomized studies are needed to validate our findings.

  • Cardiac resynchronization therapy
  • Heart failure
  • Integrated clinic
  • Multidisciplinary care
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