Cardiac Resynchronisation Therapy

Details

Title

Cardiac Resynchronisation Therapy

Type

Stage Two

Module code

HPS139

Requirement

Optional

Module objective

By the end of this module the Clinical Scientist in HSST, with respect to cardiac resynchronisation therapy, will be able to critically analyse, synthesise, evaluate and apply knowledge, and utilise a range of clinical skills to support the use of CRT therapy in a range of patients, while demonstrating the attitudes and behaviours necessary for the role of a Consultant Clinical Scientist within a patient-focused service.

Knowledge and understanding

By the end of this module the Clinical Scientist in HSST will critically analyse, synthesise, evaluate and apply their expert knowledge of cardiac resynchronisation therapy, including:

• the indications and international and national guidelines for correct CRT device pacemaker prescription, including pacing mode;
• management of peri-procedural complications, e.g. cardiac tamponade, and pneumothorax;
• potential clinical benefits of telemedicine.

Technical and clinical skills

By the end of this module the Clinical Scientist in HSST will be able to demonstrate a critical understanding of current research and its application to the performance, adaptation and mastery of a range of clinical and communication skills, and will:

• take a relevant history and assess the efficacy of CRT therapy;
• assess heart failure status;
• recognise and triage implant or device behaviour complications;
• optimise therapy delivery, including proper programming of stimulation;
• analyse and use the diagnostic data coming from the implanted device;
• identify patients likely to benefit from CRT and be aware of limitations of these techniques;
• deal with common problems associated with implantation techniques;
• recognise and respond to potential complications;
• assist with a CRT implant in a safe and logical manner;
• recognise the nature of implant difficulties and take the appropriate action to overcome these;
• appreciate when an alternative technique or approach may be required (e.g. surgical device implantation);
• programme the devices appropriately, and advise on optimisation using recognised techniques such as echocardiography;
• evaluate device diagnostic data in the clinical context and with reference to other non-invasive or invasive techniques;identify patients likely to benefit from CRT and be aware of limitations of these techniques;
• reflect on the challenges of applying research to practice in relation to the use of CRT and suggest improvements, building on a critique of available evidence.

Attitudes and behaviours

By the end of this module the Clinical Scientist in HSST will be expected to critically evaluate their own response to both normal and complex situations, consistently demonstrating the professional attributes and insights required of a Clinical Scientist in HSST working within the limits of professional competence, referring as appropriate to senior staff, and will

• foster a team approach to pacing, including a close relationship with implanters;
• commit to the audit of long-term outcomes, including infection and lead complications;
• develop a critical attitude towards a safe pacing programme in the hospital and support patients in their community with adequate pacing follow-up;
• educate patients about the treatment options available to them and explain the treatment strategies;
• work closely with other healthcare professionals as necessary: cardiologists, infection control, care of the elderly, ;
• appreciate the psychological impact of the patient’s arrhythmia illness on the patient and their family, and manage it sensitively;
• work closely with other healthcare professionals, particularly palliative care
• evaluate the psychological impact of the patient’s arrhythmia illness, device implantation and therapy on the patient and their family, and manage it sensitively;
• take a sensible, professional attitude to CRT and learn under supervision with appropriate requests for advice;
• appreciate the importance of team-working with nursing, radiographic, anaesthetic, and, if appropriate, industrial staff;
• work closely with other healthcare professionals as necessary, being aware of the importance of a multidisciplinary team in heart failure management and in maximising the benefit of CRT: cardiologists, infection control, care of the elderly, internal medicine specialists, etc.;
• deal appropriately with patients in whom CRT implantation has not been effective;
• appreciate the psychological impact of the patient’s illness on the patient and their family, and manage it sensitively;work closely with other healthcare professionals as necessary: cardiologists, infection control, care of the elderly, etc.
• recognise and remain up to date with developments in the field.