Page 139 - Simplicity is Key in CRT

For the remote clinical evaluation the patient is assessed by phone; the patient general well-being is evaluated, HF medication is reviewed, and dietary restrictions and compliance are discussed.
6 month follow-up
At 6 months, patients are evaluated during a single visit at the outpatient clinic. The follow-up plan at six months contains a 12-lead ECG, full device check-up and re-evaluation of clinical response. Finally, patient satisfaction is evaluated.
At this time general outcome measures will be evaluated. Different outcome measures have been used to get a more objective view of response to CRT. Commonly used measures are the 6 minute hall walk test (6MWT), patient activity (using device diagnostics) and echocardiographic parameters (LVEF, LVESV). Also, assessments of quality of life and psychological status can be (re-) evaluated to measure subjective patient health outcomes.
As an optimization-tool, independent of clinical response or outcome measures, the ‘Mullens check-list’ is used consistently at each follow-up moment to evaluate the need for possible further optimization of CRT [49]. This check- list consists of various potential reasons for suboptimal benefit of CRT and should therefore be evaluated step-by- step (figure 5).
Figure 5
Optimization checklist. Structured check-up for optimization of heart failure patients with CRT. Incorporating previously identified factors con- tributing to suboptimal benefit from therapy. HF = heart failure. OMT = optimal medical therapy. Intox = intoxications. VPBs = ventricular premature beats. SVT = supraventricular tachycardias. NSVT = non-sustained ventricular tachycardias. AV = atrioventricular. RV = right ven- tricular. LV = left ventricular. * = other comorbidities identified at referral review (figure 2). Adapted with permission from Mullens et al. [49].
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