Introduction Patient evaluation before cardiac resynchronisation therapy (CRT) remains heterogeneous across centres and it is suspected a proportion of patients with unfavourable characteristics proceed to implantation. We developed a unique CRT preassessment clinic (CRT PAC) to act as a final review for patients already considered for CRT. We hypothesised that this clinic would identify some patients unsuitable for CRT through updated investigations and review. The purpose of this analysis was to determine whether the CRT PAC led to savings for the National Health Service (NHS).
Methods A decision tree model was made to evaluate two clinical pathways; (1) standard of care where all patients initially seen in an outpatient cardiology clinic proceeded directly to CRT and (2) management of patients in CRT PAC.
Results 244 patients were reviewed in the CRT PAC; 184 patients were eligible to proceed directly for implantation and 48 patients did not meet consensus guidelines for CRT so were not implanted. Following CRT, 82.4% of patients had improvement in their clinical composite score and 57.7% had reduction in left ventricular end-systolic volume ≥15%. Using the decision tree model, by reviewing patients in the CRT PAC, the total savings for the NHS was £966 880. Taking into consideration the additional cost of the clinic and by applying this model structure throughout the NHS, the potential savings could be as much as £39 million.
Conclusions CRT PAC appropriately selects patients and leads to substantial savings for the NHS. Adopting this clinic across the NHS has the potential to save £39 million.
- cardiac resynchronisation therapy
- delivery of care
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Contributors BSS and coauthors have been involved in the concept/design, data acquisition, data analysis/interpretation, statistics, drafting of the manuscript, response to reviewer comments and approval of submitted version. BSS, CAR and GCW are responsible for the overall content of the paper.
Funding The study was supported by the Wellcome/EPSRC Centre for Medical Engineering (WT203148/Z/16/Z).
Competing interests Outside of the submitted work, BSS is funded by NIHR and JG has received project funding from Rosetrees Charitable Trust. JG and BP have received fellowship funding from Abbott. BJS has received support from a British Heart Foundation project grant [PG/16/108/32593]. CAR receives research funding and/or consultation fees from Abbott, Medtronic, Boston Scientific, Spectranetics and MicroPort outside of the submitted work.
Patient consent for publication Not required.
Ethics approval The study received institutional approval from Guys and St Thomas NHS Foundation Trust.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available. Original data unavailable due to patient confidentiality.
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