Better outcome at lower costs after implementing a CRT-care pathway: comprehensive evaluation of real-world data

Antonius M W van Stipdonk*, Stijn Schretlen, Wim Dohmen, Christian Knackstedt, Fabienne Beckers-Wesche, Luuk Debie, Hans-Peter Brunner-La Rocca, Kevin Vernooy

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Aims: Cardiac resynchronization therapy (CRT) requires intensive, complex, and multidisciplinary care for heart failure (HF) patients. Due to limitations in time, resources, and coordination of care, in current practice, this is often incomplete. We evaluated the effect of the introduction of a CRT-care pathway (CRT-CPW) on clinical outcome and costs. Methods and results: The CRT-CPW focused on structuring CRT patient selection, implantation, and follow-up management. To facilitate and guarantee quality, checklists were introduced. The CRT-CPW was implemented in the Maastricht University Medical Centre in 2014. Physician-led usual care was restructured to a nurse-led care pathway. A retrospective comparison of data from CRT patients receiving usual care (2012–2014, 222 patients) and patients receiving care according to CRT-CPW (2015–2018, 241 patients) was performed. The primary outcome was the composite of all-cause mortality and HF hospitalization. Hospital-related costs of cardiovascular care after CRT implantation were analysed to address cost-effectiveness of the CRT-CPW. Demographics were comparable in the usual care and CRT-CPW groups. Kaplan–Meier estimates of the occurrence of the primary endpoint showed a significant improvement in the CRT-CPW group (25.7% vs. 34.7%, hazard ratio 0.56; confidence interval 0.40–0.78; P < 0.005), at 36 months of follow-up. The total costs for cardiology-related hospitalizations were significantly reduced in the CRT-CPW group [€17 698 (14 192–21 195) vs. 19 933 (16 980–22 991), P < 0.001]. Bootstrap cost-effectiveness analyses showed that implementation of CRT-CPW would be an economically dominant strategy in 90.7% of bootstrap samples. Conclusions: The introduction of a novel multidisciplinary, nurse-led care pathway for CRT patients resulted in significant reduction of the combination of all-cause mortality and HF hospitalizations, at reduced cardiovascular-related hospital costs.

Original languageEnglish
Pages (from-to)2518-2527
Number of pages10
JournalEsc heart failure
Issue number4
Early online date31 May 2022
Publication statusPublished - Aug 2022


  • Cardiac resynchronization therapy
  • Care pathway
  • Cost-effectiveness
  • Heart failure
  • Value-based health care

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