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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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