title: Multidisciplinary care of patients receiving cardiac resynchronization therapy is associated with improved clinical outcomes.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  Integrated MC may improve 2-year event-free survival in patients receiving cardiac resynchronization therapy. Prospective randomized studies are needed to validate our findings.
authors.affiliation: Cardiac Arrhythmia Service,  Massachusetts General Hospital Heart Center, Harvard Medical School, Boston, MA 02114,  USA.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Altman
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Parks
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Schlett
authors.forename: Mary
authors.initials: M
authors.lastname: Orencole
authors.forename: Mi-Young
authors.initials: MY
authors.lastname: Park
authors.forename: Quynh A
authors.initials: QA
authors.lastname: Truong
authors.forename: Peerawut
authors.initials: P
authors.lastname: Deeprasertkul
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Moore
authors.forename: Conor D
authors.initials: CD
authors.lastname: Barrett
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Lewis
authors.forename: Saumya
authors.initials: S
authors.lastname: Das
authors.forename: Gaurav A
authors.initials: GA
authors.lastname: Upadhyay
authors.forename: E Kevin
authors.initials: EK
authors.lastname: Heist
authors.forename: Michael H
authors.initials: MH
authors.lastname: Picard
authors.forename: Jagmeet P
authors.initials: JP
authors.lastname: Singh
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D010348:Patient Care Team; D011446:Prospective Studies; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000502:physiology