Netherlands Heart Journal最新文献

Background: Despite recent advances in the treatment of acute heart failure (AHF), implementation of new evidence into clinical practice remains challenging.

Methods: We conducted a single-center descriptive exploratory study within an ongoing prospective AHF registry. Adult patients admitted with AHF, without requiring intensive care, were included consecutively. An updated local AHF protocol was developed and implemented by group-education sessions, pocket cards, and posters. Patients before (control group) and after (intervention group) implementation of the new protocol were compared in terms of compliance to the protocol and 90-day outcomes-blanking the implementation period. Subgroups entailed HF with (mildly) reduced and preserved ejection fraction.

Results: Patients were elderly, with almost half being de novo HF patients. Groups were comparable except for higher NT-proBNP in the implementation group and a higher cancer prevalence in the control group. The intervention group showed an increase in in-hospital use of acetazolamide (59.8 vs 0%, p < 0.001), in iron deficiency testing and correct iv. iron administration (42.9% vs 78.6% p ≤ 0.001). Pre-discharge installation of SGLT2 inhibitors showed a positive trend (44.2 vs 20% in HF(m)rEF patients and 29.4 vs 4% in HFpEF, both p = 0.01) HF-event-free survival at 90 days numerically favored the intervention group (29.9 vs 44.3%, p = 0.054), whereas length of hospital stay increased by 1 day (p = 0.011).

Conclusion: Implementing a local updated AHF protocol improved adoption of several evidence based AHF interventions. This may translate into improved patient outcomes, against a minor increase in hospital duration.

Background: Failure to identify the underlying cause of chest pain in patients presenting to the cardiac emergency department (ED) poses a significant health and economic challenge. Non-typical chest pain in patients without a history of cardiovascular disease often leads to uncertainty regarding appropriate follow-up care.

Research question: Does outpatient follow-up consultation with a cardiologist impact recurrent cardiac ED visits and major adverse cardiac and cerebrovascular events (MACCE) in patients with non-typical chest pain and no prior cardiovascular history?

Study design and methods: This retrospective cohort study included 429 patients presenting to the cardiac ED with non-typical chest pain and no history of cardiovascular disease. Of these, 213 patients (49.7%) received follow-up consultations with a cardiologist within three months of their index ED visit. We compared rates of recurrent (cardiac) ED visits, MACCE, and healthcare resource utilization during a one-year follow-up between patients who received follow-up consultations and those who did not.

Results: Patients with follow-up consultations had a significantly higher rate of revisits to the cardiac ED (13.6% vs. 5.1%) during the one-year follow-up period. There was no significant difference in MACCE between the two groups. Additionally, follow-up consultations were associated with an increase in healthcare resource utilization, including specialized cardiac tests.

Conclusion: This study highlights the potential drawbacks of routine follow-up consultations in this patient population and calls for further prospective research to validate these findings.

Introduction: The number of octo and nonagenarians presenting with acute coronary syndrome (ACS) is rising and underreported. Therefore, this study aims to clarify patient characteristics and compare outcomes of an initial invasive strategy versus optimal medical treatment.

Methods: All consecutive ACS patients from 2020 until 2023 were admitted, and with EHR data extracted. Multi-variation analyses were carried out in three age groups: 80-84, 85-89 and 90+.

Results: A total of 1,036 consecutive patients over 80 years old were analyzed. A predominance of women, lower rates of angiography/PCI and hypercholesterolemia were observed in the nonagenarians. CABG was only performed in the 80-84 yrs group. No differences in the complication rates (type 3a bleeding, CVA, or secondary ICU admission) between the invasive and OMT group at any age. At 3 months, a trend towards a better outcome in all-cause mortality was seen in the invasive group in the age groups: 80-84: HR 0.44 (0.19-1.04) (p = 0.06), 85-89: HR 0.46 (0.20-1.07) (p = 0.07) and significant better in 90+: HR 0.16 (0.03-0.85) (p = 0.03).

Conclusion: In this consecutive cohort of 6,168 ACS patients, 1,036 (17%) were octo- and nonagenarians. Nonagenarians differ compared to 80+ and 85+ patients. At 30 days, mortality rates were 4% in the 80-84 group, 10% in the 85-89 group (p = < 0.001), and 15% in the nonagenarians (p < 0.001). This all-comer single-center study shows that appropriate selection may be feasible for an invasive strategy in ACS octo and nonagenarians in terms of safety and outcome.

This review evaluates the 2023 European Society of Cardiology (ESC) guidelines for the management of infective endocarditis (IE) and offers insights into topics particularly relevant to clinical practice in the Netherlands. The multidisciplinary IE Working Group assessed all ESC recommendations and concluded that the majority could be endorsed, albeit with certain modifications. The IE Working Group presents a refined (and simplified) antibiotic prophylactic regimen and an updated table to guide the analysis of suspected blood culture-negative IE. Furthermore, the pivotal role of the Endocarditis Team in the management of patients with suspected and confirmed IE was reaffirmed, along with reinforced recommendations for nearly all cardiac and extracardiac imaging in these cases. Notably, a preliminary recommendation was issued for switching to oral antibiotic therapy in patients with native valve endocarditis caused by viridans streptococci, while awaiting the revision of the Dutch Working Group on Antibiotic Policy (SWAB) IE guideline. In addition, the surgical recommendations were evaluated and revised, including improved clinical criteria in case of cardiac surgery following neurological complications of IE and an advised disregard of the new class I ESC recommendation for surgery in early prosthetic valve endocarditis (< 6 months). Moreover, an additional device recommendation was proposed for the choice of (alternate) devices in case of device reimplantation after IE.

Background: Patients undergoing a transcatheter aortic valve implantation (TAVI) are at risk for Major Adverse Cardiac Events (MACE). We describe temporal trends of TAVI-related MACEs, stratified by age and sex.

Methods: We performed a retrospective analysis of TAVI patients from the Netherlands Heart Registration (NHR) between 2013 and 2022. The outcomes were: mortality at 30 days, mortality at one year, permanent pacemaker implantation at 30 days (PPI), major vascular complication at 30 days (MVC), and stroke at three days. We calculated incidence and trends in TAVI patients and their outcomes.

Results: The cohort consisted of 19,746 TAVI patients, with a mean age of 80 years. The annual number of TAVI procedures increased over the years from 786 to 2876 (p < 0.001). Initially, more women received TAVI, but the trend shifted over time to more men (p < 0.001). Outcomes incidence was: 30-day mortality (3.3%), one-year mortality (10.6%), PPI (10.7%), MVC (2.9%), and stroke (2.0%). Incidence of both mortality outcomes decreased over time (6.7% to 2.7%, and 15.8% to 8.8% for 30-day and one-year mortality, respectively), as did PPI (12.3% to 10.4%) and MVC (3.6% to 2.5%). Women had a higher incidence of MVC and stroke. Men had a higher incidence of one-year mortality and PPI, and their incidence increased more with age than it did in women.

Conclusion: The volume of TAVI procedures has increased significantly over time, while mortality, PPI, MVC, and MACE incidence have significantly decreased. Sex-specific differences in MACE outcome incidence were present.

Introduction: The left atrial appendage is the dominant source of cardioembolic stroke in patients with atrial fibrillation (AF). Contemporary guidelines recommend considering left atrial appendage occlusion (LAAO) in AF patients contraindicated to oral anticoagulation therapy (OAC), but randomized controlled trial (RCT) data for this subpopulation are lacking.

Methods: COMPARE LAAO was designed as an event-driven, multicenter, prospective, randomized, open, blinded endpoint (PROBE) trial that randomized AF patients with an increased thromboembolic risk and a contraindication to OAC 2:1 to LAAO or standard-of-care (SOC). The co-primary endpoints comprised 1) time to first occurrence of ischemic/hemorrhagic/undetermined stroke and 2) time to first occurrence of all-cause stroke/TIA/SE. The trial aimed to enroll 609 patients.

Results: After randomization of 69 patients, the trial was terminated prematurely by the sponsor due to a slow inclusion rate. Results are discussed briefly without formal statistical testing. All-cause stroke occurred in 7/48 and 2/21 patients randomized to LAAO and SOC, respectively. According to the as-treated principle, all-cause stroke occurred in 5/41 and 4/28 patients treated with LAAO and SOC. The composite of all-cause stroke/TIA/SE occurred in 10/48 and 4/21 patients randomized to and 8/41 and 6/28 patients treated with LAAO and SOC.

Conclusion: Insufficient statistical power of COMPARE LAAO impedes drawing any conclusions. Among other factors, the loss of perceived clinical equipoise among physicians proved problematic for successful trial completion. Conducting an RCT on LAAO vs SOC in OAC-ineligible patients appears infeasible globally, which threatens to preclude reimbursement in the Netherlands for these patients that have no proven alternative.

This review evaluates the 2023 European Society of Cardiology (ESC) guidelines for the management of infective endocarditis (IE) and offers insights into topics particularly relevant to clinical practice in the Netherlands. The multidisciplinary IE Working Group assessed all ESC recommendations and concluded that the majority could be endorsed, albeit with certain modifications. The IE Working Group presents a refined (and simplified) antibiotic prophylactic regimen and an updated table to guide the analysis of suspected blood culture-negative IE. Furthermore, the pivotal role of the Endocarditis Team in the management of patients with suspected and confirmed IE was reaffirmed, along with reinforced recommendations for nearly all cardiac and extracardiac imaging in these cases. Most notable, a preliminary recommendation was issued for switching to oral antibiotic therapy in patients with native valve endocarditis caused by viridans streptococci, while awaiting the revision of the Dutch Working Group on Antibiotic Policy (SWAB) IE guideline. In addition, the surgical recommendations were evaluated and revised, including improved clinical criteria in case of cardiac surgery following neurological complications of IE and an advised disregard of the new class I ESC recommendation for surgery in early prosthetic valve endocarditis (< 6 months). Moreover, an additional device recommendation was proposed for the choice of (alternate) devices in case of device reimplantation after IE.