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As a structured aid in complex care pathways, checklists have shown to improve organisation structure, homogeneity in therapy and the ability to prevent complications and therefore improve implementation of care pathways, especially in HF [37, 38]. However, checklists are not typically used in CRT care. Recent studies have investigated the role of structured checklists and other aids in clinical practice. The IMPROVE HF study, as the OPTIMIZE HF study earlier, showed that structured HF care (with the help of structured aids) improved guideline adherence in an outpatient HF population [37, 38].
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 design, patient assessments for CRT, as well as follow-up visits after implantation, are structured and effective. The office visits are organized to have device follow-up before medical follow-up to make sure device information on general HF status (heart rate and rhythm), HF diagnostics (patient activity and thoracic impedance measurement), as well as CRT specific data (percentage of biventricular pacing, arrhythmias) are available to be incorporated into the general HF management and CRT optimization program. Device measured parameters have proven to be helpful in the assessment of HF status and the ability to detect possible deterioration [39-41]. Moreover, standard incorporation of remote monitoring can further reduce outpatient visits [42-45] and has been shown to result in a significant improvement in the prediction of HF deterioration, therefore reducing the number of HF hospitalizations [45-47].
Conclusion
As care for HF patients treated with CRT is complex, multifactorial and puts a high burden on health care utilisation, 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 international, expert based structured CRT care pathway, using a multidisciplinary approach, and by implementing it into actual practice using a structured, comprehensive and practical methodology, we aim first to deliver effective and efficient therapy for CRT indicated patients and ensure early detection and management of suboptimal benefit from CRT, and second to promote the feasibility of optimising CRT care across all CRT centres.