Netherlands Heart Journal最新文献

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.

Background: Reducing AF-related symptoms and improving health-related quality of life (HRQoL) are important drivers in the decision for pulmonary vein isolation (PVI) in treating symptomatic atrial fibrillation (AF). We assessed the association between various patient characteristics, intervention, and outcome variables, and HRQoL both prior to and one year after PVI, with specific attention to groups that did not improve or were still impaired in HRQoL post PVI.

Methods: Observational, retrospective multicenter cohort study within 8 hospitals participating in the Netherlands Heart Registration (NHR). Patients who underwent PVI between 2016 and 2019 and completed the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire both prior to and one year after were included. Accepted cut-off values for impaired HRQoL and clinically important difference (CID) were used.

Results: Mean AFEQT score (n = 2,534) was 55.6 ± 19.7 prior to intervention and 79.8 ± 20.2 after. Post-PVI, 39.5% of the population was still impaired in HRQoL (< 80 points), and 19.2% failed to achieve CID (delta ≥ 5 points). Lower baseline AFEQT-score (odds ratio [OR], 0.96 [per 1‑point increase]; 95% CI, 0.96-0.97; p < 0.001) and female sex (odds ratio [OR], 1.42; 95% CI, 1.16-1.75; p < 0.001) were the most prominent related factors with impaired HRQoL post-PVI. Higher baseline AFEQT-score (odds ratio [OR], 1.04 [per 1‑point increase]; 95% CI, 1.04-1.05; p < 0.001) was strongly associated with failure to achieve CID.

Conclusion: Despite a major increase in HRQoL across the population, over one-third of patients were still impaired in HRQoL post-PVI. Multiple factors were identified that may guide counselling of AF patients about treatment choice.

Objective: The aim of this study is to gain insight into mortality rates and causes of death after major cardiac interventions, using nationwide real-world data from the Netherlands.

Methods: For this retrospective observational study, data from Statistics Netherlands and the Dutch all-payer claims database in the period 2016-2019 were used to select the intervention groups: coronary artery bypass grafting (CABG), percutaneous coronary intervention, surgical aortic valve replacement (SAVR), SAVR + CABG, mitral valve surgery, transcatheter heart valve intervention, pulmonary vein isolation and minimally-invasive maze surgery. For all interventions, survival status, date, and cause of death were retrieved. Causes of death were clustered for cardiovascular (CV) and non-CV causes by their corresponding ICD-10 code at different time intervals up to 5 years after the intervention.

Results: A total of 203,001 interventions were included, and 13.7% (27,832) of the patients died during the 5‑year follow-up. Of these, 45.1% (12,560) were CV, and 54.9% (15,272) were non-CV deaths. After coronary revascularization, valve intervention, and aortic valve intervention and coronary revascularization combined, respectively, non-CV mortality increased from 14.2%, 12.9% and 20.7% at 30 days to 44.5%, 47.0% and 44.5% after 2 years. Of all deaths up to 5 years, 54.7%, 54.3% and 55.3% were non-CV.

Conclusion: Initially main cause of death after cardiac intervention is CV-related. The proportion of non-CV deaths increases during follow-up, impacting survival for all patients up to 5 years after intervention. (Fig. 1).

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.