Jagmeet Singh, MD, Director of the Cardiac Resynchronization Therapy Program at the Massachusetts General Hospital Heart Center, discusses his team’s recent study about multidisciplinary care (MC) versus conventional care (CC) in CRT (cardiac resynchronization therapy) patients. Over a half million new patients each year in the U.S. are diagnosed with heart failure, a condition in which the heart cannot pump enough oxygenated blood to meet the needs of the body’s other organs. Many of these patients use CRT, the use of specialized pacemakers for treatment. CRT is well known to reduce morbidity and mortality in patients with heart failure, but almost one-third of CRT patients continue to remain non-responsive to the treatment. Care is fairly fragmented for CRT patients with limited cross talk within subspecialties. In late 2005 / early 2006, MGH constructed a multidisciplinary clinic in an effort to bring the subspecialties together.
Multidisciplinary care in this study consisted of three visits to the MC clinic at Mass General over a six-month period. Patients received care from physicians, nurse practitioners, technologists and support staff with expertise in heart failure, EP/arrhythmia device management and ECHO, and had scheduled walk tests, quality of life assessments, device interrogations, assessments by electrophysiologists and heart failure physicians, and echocardiograms. The patients in the conventional care group were seen as needed by each subspecialist in the EP device clinic in separate visits at varying intervals. Echocardiogram-guided optimizations were dictated by physician discretion and not performed routinely.
The big finding in this study was there was a 38 percent relative risk reduction for heart failure hospitalizations, transplant and/or mortality over a 2-year follow-up in the multidisciplinary group versus patients who received conventional care.