Cardiac resynchronization therapy-heart failure (CRT-HF) clinic: A novel model of care

Autoři: Eiran Z. Gorodeski aff001;  Christina Magnelli-Reyes aff002;  Laurie Ann Moennich aff003;  Adam Grimaldi aff002;  John Rickard aff002
Působiště autorů: Section of Heart Failure and Cardiac Transplantation, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America aff001;  Section of Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America aff002;  Heart and Vascular Research, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America aff003
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222610



Post-implant care of patients with heart failure (HF) undergoing cardiac resynchronization therapy (CRT) is not addressed in current HF or CRT guidelines and is often fragmented with poor communication between specialties. We sought to develop a new model of post-CRT care which could be implemented in busy clinical settings.

Methods and results

We designed a novel, multidisciplinary approach to standardizing post CRT care. All patients receiving a CRT device at the Cleveland Clinic between March 2017 and August 2018 were invited to be seen in the clinic 6 months post implant. A one-time collaborative visit encompassing cardiac imaging, heart failure, and electrophysiology care was performed. We recorded the operational feasibility of the clinic in terms of patient throughput as well as patient characteristics, interventions, and new diagnoses made. Between September 2017 and February 2019, 150 patients were seen in the clinic. Of these, 125 patients had their index CRT implanted for standard indications and were included in the current analysis. Approximately 45 minutes were dedicated for each patient visit. Interventions in care were made in 95% of patients, with CRT non-responders offered a higher number of interventions as compared to responders (median 3 versus 2 interventions). Types of interventions were device-related (26% of population), medication-related (74%), and referral for alternate medical services (80%).


Multidisciplinary post-implant care of patients with HF receiving CRT devices, regardless of CRT response status, is feasible and results in frequent medical interventions.

Klíčová slova:

Medicine and health sciences – Cardiology – Heart failure – Cardiac pacing – Health care – Quality of life – Biology and life sciences – Bioengineering – Biotechnology – Medical devices and equipment – Medical implants – Engineering and technology – Research and analysis methods – Bioassays and physiological analysis – Electrophysiological techniques – Cardiac electrophysiology – Electrocardiography


1. Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, et al. Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002;346(24):1845–53. doi: 10.1056/NEJMoa013168 12063368.

2. Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005;352(15):1539–49. doi: 10.1056/NEJMoa050496 15753115.

3. Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP, et al. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med. 2009;361(14):1329–38. doi: 10.1056/NEJMoa0906431 19723701.

4. Tang AS, Wells GA, Talajic M, Arnold MO, Sheldon R, Connolly S, et al. Cardiac-resynchronization therapy for mild-to-moderate heart failure. N Engl J Med. 2010;363(25):2385–95. doi: 10.1056/NEJMoa1009540 21073365.

5. Kubala M, Guedon-Moreau L, Anselme F, Klug D, Bertaina G, Traulle S, et al. Utility of Frailty Assessment for Elderly Patients Undergoing Cardiac Resynchronization Therapy. JACC Clin Electrophysiol. 2017;3(13):1523–33. doi: 10.1016/j.jacep.2017.06.012 29759834.

6. Parkash R, Philippon F, Shanks M, Thibault B, Cox J, Low A, et al. Canadian Cardiovascular Society guidelines on the use of cardiac resynchronization therapy: implementation. Can J Cardiol. 2013;29(11):1346–60. doi: 10.1016/j.cjca.2013.09.009 24182753.

7. Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J. 2013;34(29):2281–329. doi: 10.1093/eurheartj/eht150 23801822.

8. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr., Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147–239. doi: 10.1016/j.jacc.2013.05.019 23747642.

9. Rickard J, Kumbhani DJ, Popovic Z, Verhaert D, Manne M, Sraow D, et al. Characterization of super-response to cardiac resynchronization therapy. Heart Rhythm. 2010;7(7):885–9. doi: 10.1016/j.hrthm.2010.04.005 20382271.

10. Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The mini-cog: a cognitive 'vital signs' measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry. 2000;15(11):1021–7. 11113982.

11. Borson S, Scanlan JM, Chen P, Ganguli M. The Mini-Cog as a screen for dementia: validation in a population-based sample. J Am Geriatr Soc. 2003;51(10):1451–4. doi: 10.1046/j.1532-5415.2003.51465.x 14511167.

12. Arslan S, Erol MK, Gundogdu F, Sevimli S, Aksakal E, Senocak H, et al. Prognostic value of 6-minute walk test in stable outpatients with heart failure. Tex Heart Inst J. 2007;34(2):166–9. 17622362; PubMed Central PMCID: PMC1894714.

13. Drey M, Pfeifer K, Sieber CC, Bauer JM. The Fried frailty criteria as inclusion criteria for a randomized controlled trial: personal experience and literature review. Gerontology. 2011;57(1):11–8. doi: 10.1159/000313433 20407227.

14. Mullens W, Grimm RA, Verga T, Dresing T, Starling RC, Wilkoff BL, et al. Insights from a cardiac resynchronization optimization clinic as part of a heart failure disease management program. J Am Coll Cardiol. 2009;53(9):765–73. doi: 10.1016/j.jacc.2008.11.024 19245967.

15. Altman RK, Parks KA, Schlett CL, Orencole M, Park MY, Truong QA, et al. Multidisciplinary care of patients receiving cardiac resynchronization therapy is associated with improved clinical outcomes. Eur Heart J. 2012;33(17):2181–8. doi: 10.1093/eurheartj/ehs107 22613342; PubMed Central PMCID: PMC3634395.

16. Greene SJ, Butler J, Albert NM, DeVore AD, Sharma PP, Duffy CI, et al. Medical Therapy for Heart Failure With Reduced Ejection Fraction: The CHAMP-HF Registry. J Am Coll Cardiol. 2018;72(4):351–66. doi: 10.1016/j.jacc.2018.04.070 30025570.

17. Maass AH, Buck S, Nieuwland W, Brugeman J, Van Veldhuisen DJ, Van gelder IC. Importance of heart rate durng excerise for response to cardiac resynchronization therapy. J Cardiovasc Electrophsyiol 2009;20:773–780.

18. Maass AH, Vernooy K, Wijers SC, van't Sant J, Cramer MJ, Meine M, Allaart CP, De lange FJ, Prinzen FW, Gerritse B, Erdtsieck E, Scheerder CO, Hill M, Scholten M, Kloosterman M, ter Horst I, Voors AA, Vos MA, Rienstra M, van Gelder IC. Refining success of cardiac resynchronization therapy using a simple score predicting the amount of reverse ventricualr remoddeling: results fro mthe Markers and Response to CRT)MARC study. Europace 2018;20:e1–e10.

19. Patwala AY, Woods PR, Sharp L, Goldspink DF, Tan LB, Wright DJ. Maximizing patienet benefit fro mcardiac resynchronization therapy wit the addition of structured excerise training. J Am Coll Cardiol 2009;53:2332–9. doi: 10.1016/j.jacc.2009.02.063 19539142

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