Abstract 8577: Multidisciplinary Care of Patients Receiving Cardiac Resynchronization Therapy Improves Clinical Outcomes

Abstract

Background: Although cardiac resynchronization therapy (CRT) reduces morbidity and mortality in patients with heart failure, a substantial minority of patients do not respond adequately to this therapy. The objective of this study was to examine the impact of a ‘multidisciplinary care approach’ on clinical outcome. Methods: The clinical outcome in patients prospectively receiving multidisciplinary care (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. Proportional hazard models (adjusting for all potential confounders) and Kaplan-Meier estimates for time to first event curves were compared between the 2 groups, over a 2-year follow up. Outcome was measured as a combined endpoint of heart failure 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; NYHA III, 90% vs. 82%; ischemic cardiomyopathy 55% vs. 64%, p=NS, respectively). The event free survival was significantly higher in the multidisciplinary vs. conventional care group (Figure, p=0.0015). A significant reduction in clinical events was noted in the MC versus the CC group ( 0.62, 95%CI 0.47-0.84, p = 0.002) and remained significant after adjustment (HR 0.67, p=0.03). Conclusion: Integrated multidisciplinary care improves 2-year event free survival in patients receiving cardiac resynchronization therapy.