Netherlands Heart Journal最新文献

Introduction: In 2018, the Dutch CardioVascular Alliance (DCVA), a collaboration between 24 partners in the cardiovascular field, expressed the ambition to reduce the cardiovascular disease (CVD) burden in the Netherlands by 25% in 2030. This project aimed to evaluate the extent to which the activities within the DCVA contribute to a reduction in the burden defined as morbidity and mortality combined.

Methods: The role and potential impact of the DCVA was assessed. Three assessments were conducted: 1) to determine the potential impact of consortia (n = 32) using a checklist; 2) to estimate the potential health benefit (quality-adjusted life years, (QALYs)) and cost savings from a snapshot of consortia (n = 4).

Results: Most of the consortia focused on treatment (31%), followed by secondary prevention/monitoring (23%) and diagnosis (23%). Almost all consortia (n = 31) aim to reduce morbidity and two-thirds (n = 21) aim to reduce mortality. The four consortia evaluated were Check@Home, LoDoCo2, CONTRAST 2.0 and IMPRESS, with pathways in screening, treatment, treatment and diagnosis, respectively. The total estimated cumulative QALYs gained (from 2023 to 2030) were 1,694, 362, 2,783, and 3,655 respectively.

Discussion: Although it is impossible to estimate the full impact of the DCVA itself, the presented checklist and analyses may increase awareness of the different DCVA activities, roles, and consortia. Existing HTA methods can support the exploration of the potential impact generated by each consortium within the DCVA. The current portfolio of DCVA consortia contributes extensively to the DCVA goal of reducing the CVD burden, provided there is effective support for the adoption and implementation of innovations.

Background: Patients with atrial fibrillation (AF) often present with multimorbidity and may require a higher healthcare utilisation. We aimed to compare hospital healthcare utilisation among AF patients to non-cardiovascular disease (non-CVD) patients and explore the role of multimorbidity and age.

Methods: We performed a retrospective cohort study using electronic health records data from three hospitals in the Netherlands. Patients aged ≥ 18 years with ≥ 1 inpatient or outpatient presentation were included. Diagnoses were determined using the International Classification of Diseases and Related Health Problems 10 codes and linked with the Dutch Hospital Data Clinical Classification Software to determine comorbidities.

Results: A total of 226,991 patients, 5,127 (2%) had AF. AF patients had significantly more outpatient visits (6.6 vs 3.6), emergency department visits (0.9 vs 0.2), and in-hospital days (4.0 vs 1.5) compared to non-CVD patients/year (all p < 0.001). AF patients saw more frequently multiple specialists, (13% vs 2% consulting ≥ 5 specialists, p < 0.001). Number of outpatient visits for AF patients increased with number of comorbidities: from a median of 1 (0-1 comorbidities) to 11 (≥ 4 comorbidities) (p < 0.001). Similarly, in-hospital days increased from 0.6 days (0-1 comorbidities) to 8.2 days (≥ 4 comorbidities) (p < 0.001). Regardless of age, AF patients had more outpatient and emergency department visits and more days in hospital days compared to non-CVD patients (all p < 0.001).

Conclusions: Patients with AF had significantly greater hospital healthcare utilisation use compared to non-CVD patients, independent of age. Therefore, there is a need for more cohesive care pathways in AF patients to reduce healthcare utilisation.

Heart transplantation is considered as the ultimate treatment for patients with advanced heart failure (HF). Chronic HF is associated with hepatic congestion and reduced cardiac output, which can lead to progressive liver disease. This issue is particularly relevant in patients with congenital heart disease, especially those with a single functional ventricle managed through Fontan-type surgery. The presence of advanced liver disease may contraindicate isolated heart transplantation and thus require consideration of combined heart-liver transplantation (CHLT). However, consensus criteria for CHLT have not yet been established. To illustrate the clinical and scientific discussions on this topic, we present the clinical course of two patients with a Fontan circulation who were evaluated for CHLT and discuss decision-making factors based on a review of current literature. We conclude that establishing a CHLT program represents a promising therapeutic pathway for patients in the Netherlands with advanced HF and concomitant liver disease. Both isolated heart transplantation and CHLT are viable treatment approaches for carefully selected patients with HF and liver disease. However, early identification of potential candidates and timely referral for a comprehensive evaluation are essential for the effective management of this high-risk patient group.

Background: The Dutch ACS working group endorses a delayed invasive approach for non-ST segment elevation myocardial infarction (NSTEMI) patients as safe and acceptable. We analysed the timing of invasive coronary angiography (ICA) and percutaneous coronary intervention (PCI) for all patients admitted with NSTEMI.

Methods: For this retrospective observational cohort study initiated by the Netherlands Heart Registration, we extracted Dutch medical claims and diagnosis codes for all NSTEMI patients who underwent PCI. Primary outcome was the time from hospital admission to ICA and PCI in patients admitted to PCI and non-PCI centres. Secondary analyses included the time from ICA to PCI and variation among individual PCI centres.

Results: A total of 36,573 NSTEMI patients (median age 68 years, 30% female) were included in the analysis. 24,857 patients (68%) were admitted to a hospital with PCI facilities (n = 30) and 11,716 patients (32%) to a hospital without PCI on site (n = 42). ICA was performed < 3 days (72 h) in 33,476 patients (92%). For patients admitted in PCI centres ICA was performed < 3 days in 94% (n = 23,328), median 0 days (IQR 0-1) vs 87% (n = 10,148), median 1 day (IQR 1-2) in non-PCI centres. The longest delay (median 3 days; IQR 2-5) between ICA and PCI occurred in patients first admitted to non-PCI centres and transferred after local ICA.

Conclusions: ICA within three days is achieved in a very high percentage of patients in both PCI and non-PCI centres. A clearly larger percentage receives PCI within three days when directly admitted to a PCI centre.

Background: Hospital care shifted to home may contribute to sustainability of health care. It is uncertain if home-based electrical cardioversion (ECV) is feasible.

Methods: RACE‑6 is a prospective proof-of-concept pilot study on feasibility of ECV of persistent symptomatic atrial fibrillation (AF) at patient's homes. It is performed by a mobile nurse-led team, including an emergency care practitioner (ECP) and a sedation nurse, and is remotely supervised by a cardiologist with an ambulance (driver) standby. To ensure safe ECV, the ECP assessed the patients' homes beforehand for accessibility, hygiene, adequate space and light, electrical interference and explosive sources, electricity network stability, and the presence of an adequate informal caregiver overnight.

Results: Six consenting patients with an uneventful previous in-hospital ECV for persistent AF developed one or two symptomatic recurrences and underwent in total 8 separate ECV attempts under conscious sedation at their homes. In all patients sinus rhythm returned and there were no early or late complications. Patients invariably preferred home cardioversion over cardioversion in-hospital.

Discussion: Although applied in highly selected patients, home cardioversion may be extended to a wider selection of patients with persistent AF or even to patients with paroxysmal AF in need of acute restoration of sinus rhythm. Shortening time to cardioversion and early restoration of sinus rhythm may enhance patients' quality of life and postpone AF progression. Home cardioversion may appear safe and improve cost-effectiveness of care but randomized controlled trials are needed to show that home cardioversion may keep AF patients out of the hospital and contribute to the sustainability of health care.

Conclusion: Cardioversion at home is feasible and is generally well received by patients.

Background: The COVID-19 lockdown negatively impacted physical activity (PA) and sedentary behaviour (SB) levels of the Dutch patients with cardiovascular diseases (CVD), but little is known whether these levels returned to pre-pandemic levels. In this study, we evaluated changes in SB and moderate-to-vigorous PA (MVPA) in CVD patients before, during, and after the COVID-19 pandemic and investigated which factors contributed to not returning to pre-pandemic sedentary levels.

Methods: 1,028 Dutch CVD patients participated in this prospective cohort study, where we assessed SB and MVPA before (2018), during (2020), and after (2023) the COVID-19 pandemic using validated questionnaires. Linear mixed model analyses were used to investigate changes over time. Binary logistic regression analyses were performed to examine factors associated with not returning to pre-pandemic SB levels.

Results: SB levels significantly increased from 7.8 h/day at pre-pandemic assessment to 8.7 h/day during lockdown and then significantly decreased to 8.5 h/day at the post-pandemic assessment, but did not return to pre-pandemic levels (p = 0.006). MVPA did not significantly change over time. Lower pre-pandemic SB levels, a larger increase in SB during lockdown, self-reported residual complaints after COVID-19, and diagnosis of arrhythmias at baseline were associated with not returning to pre-pandemic SB levels.

Conclusion: Sedentary time in CVD patients did not return to pre-pandemic levels, 3 years following initial COVID-19 lockdown, while levels of MVPA did not change over time. These findings suggest that lifestyle interventions could be considered to reactivate CVD patients and lower their risk of disease progression and adverse health outcomes. SB bij CVD-patiënten keerde niet terug naar het niveau van voor de pandemie, drie jaar na de eerste COVID-19 lockdown, terwijl MVPA onveranderd bleef. Deze bevindingen suggereren dat leefstijlinterventies overwogen kunnen worden om CVD-patiënten opnieuw te activeren en hun risico op ziekteprogressie en nadelige gezondheidseffecten te verlagen.