Page 131 - Simplicity is Key in CRT

Methods
The CRT care pathway, and structured aids as described in this paper, are based on a series of discussions of current evidence with highly experienced physicians in CRT. The specialists involved were not appointed by any professional European or national association, but rather a group of experts experiencing the same clinical practice issues and recognizing the overall problem of heterogeneity of practice and related suboptimal treatment in CRT. Therefore there is no explicit endorsement of any professional organisation for the care pathway as described in this paper. The specialists involved were all experienced implanting and supervising CRT specialists, either primarily focussed onHForEP,providingamultidisciplinaryfocus.MeetingsbaseduponconcernsaboutclinicalCRTcareasdescribed in the introduction were initiated. Three expert centres (Maastricht University Medical Centre, the Netherlands; Liverpool Heart & Chest Hospital, England; and Rigshospitalet Copenhagen, Denmark) were invited to participate in these discussion meetings. First evaluating the ‘current state’ of CRT care in the hospitals involved, focussing on local issues related to the general problems in CRT care, and the processes involved. Hereafter, thorough analysis and literature review, with live and remote expert clinician-led consensus workshops were organised, involving both expert clinicians and external consultants. This methodology ensured that the consensus was driven by three imperatives: to deliver best clinical quality and safety outcomes for patients, to deliver the best possible patient experience and to optimise cost of care across the care continuum. The result was a “model CRT care pathway” with structured aids as described in this paper.
Results
CRT care pathway design
Figure 1 depicts an overview of the consensus CRT pathway. This model pathway was the result of the consensus meetings combining minimal medical content deemed necessary to guarantee adequate guidance of CRT patients and local experiences from CRT care processes. Individual steps in the model pathway will be described in detail.
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