Netherlands Heart Journal最新文献

In recent years, there have been numerous developments in the field of coronary physiology with the addition of new indices for the evaluation of the coronary microcirculation, such as invasive measurement of absolute coronary blood flow and microvascular resistance. This has resulted in more accurate diagnostic tools for patients with angina and no obstructive coronary artery disease (ANOCA), with the possibility to distinguish different endotypes of coronary microvascular dysfunction (CMD). Because of the growing recognition of ANOCA and, along with that, the increasing application of coronary function testing due to the latest guideline recommendations, it is timely and important to further explain the concept of absolute coronary flow, microvascular resistance, and the latest addition to the field: Microvascular Resistance Reserve (MRR). Differentiation between specific endotypes of CMD will help to develop tailored therapy for ANOCA patients.

Background: Lipid-lowering medication reduces the risk of future cardiovascular events and mortality, yet adherence is often disappointing. This study evaluates adherence rates of lipid-lowering medication and its subtypes during the first year following acute and elective percutaneous coronary intervention (PCI) in the Netherlands.

Methods: This retrospective cohort study utilized data from a nationwide all-payer claims database managed by Vektis, containing all medical care claims reimbursed by Dutch national insurance companies. We included 97,176 patients who underwent PCI in 2018-2020. Adherence was defined as a medication possession rate ≥ 80%.

Results: Adherence rates 0-3 months post-elective PCI ranged from 71-73% among the years and remained stable over the year following PCI. For acute PCI, adherence rates 0-3 months post-acute PCI were initially higher (79-81%) but declined to 74-76% during the year following PCI. During the year following PCI, adherence rates for ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors increased slightly to about 13%, respectively 2%, while statin adherence decreased. For statin subtypes, adherence rates for rosuvastatin increased at the expense of simvastatin, with adherence for atorvastatin and other statins remaining relatively stable. Lower adherence rates were observed among females and patients ≥ 80 years compared to males and younger patients.

Conclusion: This study found lipid-lowering medication adherence 1 year post-elective PCI ranged from 71-73% and post-acute PCI from 74-76%. Lower adherence rates were observed in women and elderly patients. Adherence rates of ezetimibe and PCSK9 inhibitors increased throughout the year following PCI, while statin use decreased.

Background: The rising prevalence of atrial fibrillation has led to increasing the numbers of pulmonary vein isolations. Optimising care pathway efficiency is essential for sustainable healthcare delivery. This study aimed to evaluate the impact of closure devices (CD) within the care pathway on hospital stay, patient satisfaction, staff workload, and costs, following catheter ablation for atrial fibrillation.

Methods: This study compared the standard care pathway following catheter ablation using manual compression (MC, December 2023-February 2024) to a modified pathway incorporating suture-mediated CD (March-May 2024). Primary outcomes included process indicators (e.g., hospitalisation duration), clinical outcomes (e.g., bleeding complications), and patient experience. Secondary outcomes included staff experience and healthcare costs associated with procedural changes.

Results: A total of 159 patients participated (MC: 81 patients, CD: 78 patients). Patients received an average of 2 percutaneous sutures. Treatment with CDs resulted in a 3.7-hour reduction in hospitalisation duration (p <. 001), 10-minute shorter procedure time in first-time ablations (p = .006), and 4‑hour shorter bed rest (p <. 001). Patients experienced less pain, measured using the Numeric Rating Scale (median 3 vs 1, p = .001), and used less pain medication (p = .006). Discharge comfort was higher in the CD group (p = .009), while complication rates remained similar. 24 nurses participated in the questionnaire. Most nurses reported improved time efficiency and workday organisation. Costs were similar across groups.

Conclusion: CDs improve care pathways after atrial fibrillation ablation by reducing hospitalisation time, enhancing patient comfort, and improving workflow efficiency without increasing complications.

In the field of cardiology and cardiovascular research, the underrepresentation of female leaders persists despite efforts to promote equality. As this phenomenon could have various reasons, we investigated the influence of intrinsic and extrinsic motivation on the representation of women in leadership roles. In this pilot study, we explored the motivation of Dutch cardiovascular PhD candidates for pursuing leadership positions through a survey. Among 143 respondents (97 female, 46 male), family planning did not seem to impact leadership ambitions as much as the desire to work part-time in the future. Of the participating women, 12% stated that a female quota would encourage them to pursue a leadership position. Interestingly, communal traits, which are typically associated with femininity, were perceived as hampering towards leadership by women but not by men. Our results show that gender stereotypes continue to influence cardiology careers, and that initiatives aimed at overall cultural change may be more supportive for future female leaders than single policy measures.

Introduction: The accessibility of left ventricular assist device (LVAD) therapy is a crucial factor in the survival and quality of life of patients suffering from advanced heart failure. However, there is a lack of clarity regarding the utilization of this therapy across regions in the Netherlands as well as whether any disparities exist based on socioeconomic status (SES). This study aimed to determine the utilization of LVAD therapy at a regional level using administrative data and to identify potential disparities based on SES by comparing postal code data to demographic governmental data.

Methods: All patients aged 16 or older who underwent a primary LVAD implantation between 2015 and 2024 were included. The data was visualized with a heatmap using Python.

Results: A total of 710 patients received an LVAD during the study period. LVAD utilization was lower in the southernmost regions compared to the northernmost regions and varied in the central regions. An ANOVA test between SES groups did not show significant differences in LVAD utilization (p = 0.20).

Conclusion: The findings of this study indicate that there are notable variations in the utilization of LVAD therapy across different geographical regions in the Netherlands. Nevertheless, no differences in LVAD use were found between areas with different SES categories. Future research should focus on identifying the underlying factors associated with referral for advanced heart failure therapies to ensure equitable access to LVAD therapy.