PO-03-080 OPTIMIZING POST-IMPLANT CRT MANAGEMENT

Abstract

Implementing a post-implant cardiac resynchronization therapy (CRT) clinic using a combined electrophysiology (EP) & heart failure (HF) advanced practice provider (APP) model may improve subspecialty collaboration & prevent delays in device & medical optimization. Some previously described models evaluate patients 6 months post-procedure. Early follow-up post-implant may further improve response. To determine if a 1 month post-implant device interrogation provides actionable data to improve CRT response at 6 months using a dual-APP multidisciplinary model. We designed a multidisciplinary clinic to formally evaluate patients after CRT device implant. The team involves an advanced HF APP, an EP APP & a HF nurse. Standard device clinic follow up is maintained with the addition of a device interrogation at 1 month to evaluate device function & CRT pacing. Interventions are made at 1 month as necessary. Patients are then seen in the multidisciplinary clinic 6 months following implant & undergo device interrogation, ECG, echocardiogram, & 6-minute walk test. Patients are simultaneously seen by the APPs & a unified plan of care is developed. The electronic medical records were reviewed prospectively for clinical characteristics pre-implant & at 1 & 6 months post-implant, which were summarized with descriptive statistics, including correlation between 1 month data & 6 month CRT response. CRT responders at 6 months were defined as having an LVEF improvement of ≥5% & a reduction in LVESVi ≥10%. Ninety-six patients seen in the clinic from September 2020 to April 2022 were evaluated. The mean age was 70 years; 66 (69%) were male; 40 (42%) had ischemic cardiomyopathy; 53 (56%) had no documented arrhythmia history prior to device implant; 13 (13.5%) were considered to have permanent atrial fibrillation (AF). Of these patients, 52 (54%) were considered CRT responders at 6 months. One month CRT pacing >95% correlated with 6 month CRT response (coefficient of 0.11, std error 0.04, p= 0.01). PVC burden >5% negatively correlated with CRT response (coefficient of 0.15, std error 0.15, p=.02). AF burden did not correlate with CRT response (coefficient of 0.01, std error 0.01, p=0.14). Multivariate analysis did not show these variables to be independently predictive of CRT response. An APP-led, early post-implant evaluation of CRT patients may provide an opportunity to improve six-month CRT response.