Netherlands Heart Journal最新文献

Background: Patent foramen ovale (PFO) is increasingly recognized as a cause of stroke, with a prevalence of approximately 25% in the general population. Consequently, the likelihood of encountering a 'bystander PFO' in young patients who have experienced a stroke seems significant. To aid in identifying patients with a PFO-related cryptogenic stroke, an interdisciplinary Heart-Stroke Team (HST) has been established. This team evaluates patients who have suffered from stroke and were diagnosed with a PFO to assess its potential contribution. Understanding the anatomical features of PFOs associated with stroke is essential for decision-making. This study examines the PFO characteristics of all patients who underwent percutaneous PFO closure for cryptogenic stroke at two congenital heart disease institutions in the Netherlands.

Methods: Data on all patients who underwent PFO closure from 2016 to 2022 were collected. Anatomical characteristics were measured using transesophageal echocardiography and analyzed by two cardiologists.

Results: In total, 223 patients underwent PFO closure. The mean age was 42.8 ± 10.7 years, with 115 (51.6%) being male. Approximately 80% of all patients had at least one risk-enhancing PFO feature (moderate to severe shunt and/or atrial septal aneurysm of > 10 mm).

Conclusion: Although all patients accepted for percutaneous PFO closure were individually assessed by a dedicated HST, 20% had a PFO without risk-enhancing features but were still accepted for closure due to other reasons. This highlights the importance of careful individual assessment of young stroke patients with a PFO. Future studies are needed to identify the characteristics that contribute to stroke in these patients.

Introduction: In critically ill patients with trigger-induced atrial fibrillation, there are no definitive recommendations on the use of anticoagulation. This study aimed to evaluate the association between anticoagulation therapy and outcomes (i.e. thromboembolism, bleeding and mortality) and examine prescription patterns in high-risk individuals based on CHA₂DS₂-VASc scores.

Methods: A systematic search was conducted to identify studies reporting on anticoagulation prescription, thromboembolism, bleeding, and mortality. Anticoagulation rates and CHA₂DS₂-VASc scores were correlated, and a meta-analysis was conducted to compare short- and long-term outcomes.

Results: Anticoagulation prescription rates ranged from 3 to 86%; in over 50% of patients, CHA₂DS₂-VASc scores were ≥ 2 (n = 28 studies). A meta-analysis of eight observational studies, in which 95% of patients had sepsis/infection as the precipitant, demonstrated no association between anticoagulation and reduced short-term thromboembolism (OR 0.89, 95% CI 0.61-1.28) or increased bleeding (OR 1.05, 95% CI 0.90-1.22). Short-term mortality was lower in the anticoagulation group (OR 0.54, 95% CI 0.39-0.75), but a higher long-term thromboembolic risk was observed (OR 1.45, 95% CI 1.04-2.03).

Conclusion: The prescription of anticoagulation in critically ill patients with TIAF is highly variable. There is no clear evidence of benefit or harm, and neither routine use nor systematic omission is supported.

Background: Despite advancements in diagnostics and treatment strategies, infective endocarditis continues to carry a substantial morbidity and mortality risk. In addition, the field of infective endocarditis contains many gaps in evidence, as international guidelines are predominantly based on low-level evidence. To improve infective endocarditis care and survival rates in the Netherlands, adequate evaluation of diagnostics, treatment strategies and outcomes is essential.

Methods: To address this need, a new infective endocarditis registry has been developed by the multidisciplinary ENDOCOR working group with the aim of facilitating nationwide quality control, improving infective endocarditis patient care, and contributing to the numerous gaps in evidence. To optimize data collection, facilitated by the Netherlands Heart Registration (NHR), a pilot project was launched in January 2023 across three selected hospitals.

Results: The findings from the first 150 registered patients were presented to highlight the registry's potential. Following the pilot, many more centres have initiated data collection, demonstrating national engagement and scalability of the initiative.

Conclusion: This article outlines the purpose of ENDOCOR, presents initial pilot data and illustrates the potential of the new national infective endocarditis registry to enhance patient care and support future research.

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.