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multidisciplinary CRT care program was evaluated and compared to a retrospective conventional care group of patients. This study has confirmed that a multidisciplinary approach in CRT was associated with improved outcomes [64].
Another objective of the CRT care pathway is to address the issue of resource utilisation and healthcare costs in CRT care. In many hospitals, patients suitable for CRT have to go through multiple visits with a variety of doctors and departments [11]. In this CRT care pathway, the patient assessments for CRT, as well as follow-up visits after implantation, are structured and effective. The office visits are planned to have device follow-up before medical follow-up to make sure device information on general HF status (heart rate and rhythm), and HF diagnostics (patient activity and thoracic impedance measurement), as well as CRT specific data (percentage of biventricular pacing, arrhythmias) are available to incorporate into the general heart failure management and CRT optimization. Device measured parameters have proven to be helpful in the assessment of HF status and the ability to detect possible deterioration [64-67]. Moreover standard incorporation of remote monitoring can reduce outpatient visits and have been shown to result in a significant improvement in the prediction of heart failure deterioration and improved outcomes resulting in a reduction of HF hospitalizations [68-72].
It is key for the success of any standardized process that roles and responsibilities are clearly defined, described and implemented. In addition, different local rules may require different timings for follow-up and patient contact. The roles and visit types and timings described in this paper may not align with the roles and responsibilities and requirements in other clinics. They are intended to give guidance in identifying appropriate functions and disciplines that should be involved and suggest visit timing when setting up/improving a CRT care pathway in any type of clinic. Adjustments to fit local rules and requirements are expected.
Conclusion
As the HF population eligible for CRT is rapidly expanding, there is a need to implement a structured and integrated pathway in order to optimize costs, improve efficiency and, most important, improve clinical outcomes. By introducing this consensus CRT care pathway, using a multidisciplinary approach, we aim to deliver effective and efficient therapy for CRT indicated HF patients and ensure early detection and management of suboptimal benefit from CRT.