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  • 1
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    Online Resource
    Abstract 15823: Diminished Vasoresponsiveness in Patients With Heart Failure
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation Vol. 142, No. Suppl_3 ( 2020-11-17)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 142, No. Suppl_3 ( 2020-11-17)
    Abstract: Introduction: Vasoplegia is a severe complication after cardiac surgery and is associated with impaired clinical outcome. Pre-operative heart failure (HF) is considered an independent predictor of post-operative vasoplegia. We hypothesize that HF patients are more susceptible to vasoplegia due to altered vascular responsiveness. In this study, vasoresponsiveness in patients undergoing cardiac surgery for HF is investigated. Methods: A prospective, observational study was conducted at Leiden University Medical Center. We included patients with HF (N=18) and without HF (N=18) who underwent cardiac surgery on cardiopulmonary bypass. Vasoresponsiveness was assessed at 4 different timepoints: 1) before induction, 2) after induction, 3) after cessation of cardiopulmonary bypass and 4) on the first postoperative day. The vascular response was recorded as change in systemic vascular resistance (SVR) after the administration of phenylephrine (bolus 2 μg/kg). Results: Thirty-six patients were included [67 (61-71) years, 78% male]. Vascular responsiveness was significantly attenuated in patients with HF compared to controls. The response to phenylephrine was already diminished at baseline in HF patients and was almost abolished after cessation of cardiopulmonary bypass (Figure). Roughly the same pattern of vasoresponsiveness was found when excluding patients that received norepinephrine. Moreover, HF patients required a significantly higher amount of noradrenaline [169.80 (IQR 14.77-318.97) ug/kg] compared to controls [3.61 (IQR 0-41.60) ug/kg] to maintain similar SVR during the first 24h postoperatively. Conclusions: The vascular responsiveness is altered in patients with HF and this might explain the higher prevalence of vasoplegia in this patient population.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.142.suppl_3.15823
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 1466401-X
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  • 2
    Online Resource
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    Clinical and economic impact of HeartLogic™ compared with standard care in heart failure patients
    Wiley ; 2021
    In:  ESC Heart Failure Vol. 8, No. 2 ( 2021-04), p. 1541-1551
    Details
    In: ESC Heart Failure, Wiley, Vol. 8, No. 2 ( 2021-04), p. 1541-1551
    Abstract: The implantable cardiac defibrillator/cardiac resynchronization therapy with defibrillator‐based HeartLogic™ algorithm has recently been developed for early detection of impending decompensation in heart failure (HF) patients; but whether this novel algorithm can reduce HF hospitalizations has not been evaluated. We investigated if activation of the HeartLogic algorithm reduces the number of hospital admissions for decompensated HF in a 1 year post‐activation period as compared with a 1 year pre‐activation period. Methods and results Heart failure patients with an implantable cardiac defibrillator/cardiac resynchronization therapy with defibrillator with the ability to activate HeartLogic and willingness to have remote device monitoring were included in this multicentre non‐blinded single‐arm trial with historical comparison. After a HeartLogic alert, the presence of HF symptoms and signs was evaluated. If there were two or more symptoms and signs apart from the HeartLogic alert, lifestyle advices were given and/or medication was adjusted. After activation of the algorithm, patients were followed for 1 year. HF events occurring in the 1 year prior to activation and in the 1 year after activation were compared. Of the 74 eligible patients (67.2 ± 10.3 years, 84% male), 68 patients completed the 1 year follow‐up period. The total number of HF hospitalizations reduced from 27 in the pre‐activation period to 7 in the post‐activation period ( P  = 0.003). The number of patients hospitalized for HF declined from 21 to 7 ( P  = 0.005), and the hospitalization length of stay diminished from average 16 to 7 days ( P  = 0.079). Subgroup analysis showed similar results ( P  = 0.888) for patients receiving cardiac resynchronization therapy during the pre‐activation period or not receiving cardiac resynchronization therapy, meaning that the effect of hospitalizations cannot solely be attributed to reverse remodelling. Subanalysis of a single‐centre Belgian subpopulation showed important reductions in overall health economic costs ( P  = 0.025). Conclusion Activation of the HeartLogic algorithm enables remote monitoring of HF patients, coincides with a significant reduction in hospitalizations for decompensated HF, and results in health economic benefits.
    Type of Medium: Online Resource
    ISSN: 2055-5822 , 2055-5822
    URL: Issue
    URL: Article
    DOI: 10.1002/ehf2.v8.2
    DOI: 10.1002/ehf2.13252
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2814355-3
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  • 3
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    The Box—eHealth in the Outpatient Clinic Follow-up of Patients With Acute Myocardial Infarction: Cost-Utility Analysis
    JMIR Publications Inc. ; 2022
    In:  Journal of Medical Internet Research Vol. 24, No. 4 ( 2022-4-25), p. e30236-
    Details
    In: Journal of Medical Internet Research, JMIR Publications Inc., Vol. 24, No. 4 ( 2022-4-25), p. e30236-
    Abstract: Smartphone compatible wearables have been released on the consumers market, enabling remote monitoring. Remote monitoring is often named as a tool to reduce the cost of care. Objective The primary purpose of this paper is to describe a cost-utility analysis of an eHealth intervention compared to regular follow-up in patients with acute myocardial infarction (AMI). Methods In this trial, of which clinical results have been published previously, patients with an AMI were randomized in a 1:1 fashion between an eHealth intervention and regular follow-up. The remote monitoring intervention consisted of a blood pressure monitor, weight scale, electrocardiogram device, and step counter. Furthermore, two in-office outpatient clinic visits were replaced by e-visits. The control group received regular care. The differences in mean costs and quality of life per patient between both groups during one-year follow-up were calculated. Results Mean costs per patient were €2417±2043 (US $2657±2246) for the intervention and €2888±2961 (US $3175±3255) for the control group. This yielded a cost reduction of €471 (US $518) per patient. This difference was not statistically significant (95% CI –€275 to €1217; P=.22, US $–302 to $1338). The average quality-adjusted life years in the first year of follow-up was 0.74 for the intervention group and 0.69 for the control (difference –0.05, 95% CI –0.09 to –0.01; P=.01). Conclusions eHealth in the outpatient clinic setting for patients who suffered from AMI is likely to be cost-effective compared to regular follow-up. Further research should be done to corroborate these findings in other patient populations and different care settings. Trial Registration ClinicalTrials.gov NCT02976376; https://clinicaltrials.gov/ct2/show/NCT02976376 International Registered Report Identifier (IRRID) RR2-10.2196/resprot.8038
    Type of Medium: Online Resource
    ISSN: 1438-8871
    URL: Article
    DOI: 10.2196/30236
    Language: English
    Publisher: JMIR Publications Inc.
    Publication Date: 2022
    detail.hit.zdb_id: 2028830-X
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  • 4
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    Effect of Smartphone-Enabled Health Monitoring Devices vs Regular Follow-up on Blood Pressure Control Among Patients After Myocardial Infarction : A Randomized Clinical Trial
    American Medical Association (AMA) ; 2020
    In:  JAMA Network Open Vol. 3, No. 4 ( 2020-04-16), p. e202165-
    Details
    In: JAMA Network Open, American Medical Association (AMA), Vol. 3, No. 4 ( 2020-04-16), p. e202165-
    Type of Medium: Online Resource
    ISSN: 2574-3805
    URL: Article
    DOI: 10.1001/jamanetworkopen.2020.2165
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2020
    detail.hit.zdb_id: 2931249-8
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  • 5
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    Improved prehospital triage for acute cardiac care: results from HART-c, a multicentre prospective study
    Springer Science and Business Media LLC ; 2023
    In:  Netherlands Heart Journal Vol. 31, No. 5 ( 2023-05), p. 202-209
    Details
    In: Netherlands Heart Journal, Springer Science and Business Media LLC, Vol. 31, No. 5 ( 2023-05), p. 202-209
    Abstract: Cardiac symptoms are one of the most prevalent reasons for emergency department visits. However, over 80% of patients with such symptoms are sent home after acute cardiovascular disease has been ruled out. Objective The Hollands-Midden Acute Regional Triage—cardiology (HART-c) study aimed to investigate whether a novel prehospital triage method, combining prehospital and hospital data with expert consultation, could increase the number of patients who could safely stay at home after emergency medical service (EMS) consultation. Methods The triage method combined prehospital EMS data, such as electrocardiographic and vital parameters in real time, and data from regional hospitals (including previous medical records and admission capacity) with expert consultation. During the 6‑month intervention and control periods 1536 and 1376 patients, respectively, were consulted by the EMS. The primary endpoint was the percentage change of patients who could stay at home after EMS consultation. Results The novel triage method led to a significant increase in patients who could safely stay at home, 11.8% in the intervention group versus 5.9% in the control group: odds ratio 2.31 (95% confidence interval (CI) 1.74–3.05). Of 181 patients staying at home, only 1 ( 〈  1%) was later diagnosed with ACS; no patients died. Furthermore the number of interhospital transfers decreased: relative risk 0.81 (95% CI 0.67–0.97). Conclusion The HART‑c triage method led to a significant decrease in interhospital transfers and an increase in patients with cardiac symptoms who could safely stay at home. The presented method thereby reduced overcrowding and, if implemented throughout the country and for other medical specialties, could potentially reduce the number of cardiac and non-cardiac hospital visits even further.
    Type of Medium: Online Resource
    ISSN: 1568-5888 , 1876-6250
    URL: Article
    DOI: 10.1007/s12471-023-01766-3
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2365465-X
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  • 6
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    Referral and participation in cardiac rehabilitation of patients following acute coronary syndrome; lessons learned
    Elsevier BV ; 2021
    In:  IJC Heart & Vasculature Vol. 36 ( 2021-10), p. 100858-
    Details
    In: IJC Heart & Vasculature, Elsevier BV, Vol. 36 ( 2021-10), p. 100858-
    Type of Medium: Online Resource
    ISSN: 2352-9067
    URL: Article
    DOI: 10.1016/j.ijcha.2021.100858
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 2818464-6
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  • 7
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    Managing Hospital Capacity: Achievements and Lessons from the COVID-19 Pandemic
    Cambridge University Press (CUP) ; 2022
    In:  Prehospital and Disaster Medicine Vol. 37, No. 5 ( 2022-10), p. 600-608
    Details
    In: Prehospital and Disaster Medicine, Cambridge University Press (CUP), Vol. 37, No. 5 ( 2022-10), p. 600-608
    Abstract: The coronavirus disease 2019 (COVID-19) pandemic challenged health care systems in an unprecedented way. Due to the enormous amount of hospital ward and intensive care unit (ICU) admissions, regular care came to a standstill, thereby overcrowding ICUs and endangering (regular and COVID-19-related) critical care. Acute care coordination centers were set up to safely manage the influx of COVID-19 patients. Furthermore, treatments requiring ICU surveillance were postponed leading to increased waiting lists. Hypothesis: A coordination center organizing patient transfers and admissions could reduce overcrowding and optimize in-hospital capacity. Methods: The acute lack of hospital capacity urged the region West-Netherlands to form a new regional system for patient triage and transfer: the Regional Capacity and Patient Transfer Service (RCPS). By combining hospital capacity data and a new method of triage and transfer, the RCPS was able to effectively select patients for transfer to other hospitals within the region or, in close collaboration with the National Capacity and Patient Transfer Service (LCPS), transfer patients to hospitals in other regions within the Netherlands. Results: From March 2020 through December 2021 (22 months), the RCPS West-Netherlands was requested to transfer 2,434 COVID-19 patients. After adequate triage, 1,720 patients with a mean age of 62 (SD = 13) years were transferred with the help of the RCPS West-Netherlands. This concerned 1,166 ward patients (68%) and 554 ICU patients (32%). Overcrowded hospitals were relieved by transferring these patients to hospitals with higher capacity. Conclusion: The health care system in the region West-Netherlands benefitted from the RCPS for both ward and ICU occupation. Due to the coordination by the RCPS, regional ICU occupation never exceeded the maximal ICU capacity, and therefore patients in need for acute direct care could always be admitted at the ICU. The presented method can be useful in reducing the waiting lists caused by the delayed care and for coordination and transfer of patients with new variants or other infectious diseases in the future.
    Type of Medium: Online Resource
    ISSN: 1049-023X , 1945-1938
    URL: Article
    DOI: 10.1017/S1049023X22001169
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2162069-6
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  • 8
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    MYOCARDIAL INFARCTION CARE IN SOCIOECONOMIC ENVIRONMENTS - CLAIMS DATA ANALYSIS
    Elsevier BV ; 2021
    In:  Journal of the American College of Cardiology Vol. 77, No. 18 ( 2021-05), p. 1639-
    Details
    In: Journal of the American College of Cardiology, Elsevier BV, Vol. 77, No. 18 ( 2021-05), p. 1639-
    Type of Medium: Online Resource
    ISSN: 0735-1097
    URL: Article
    DOI: 10.1016/S0735-1097(21)02995-8
    RVK:
    XA 17760
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 1468327-1
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  • 9
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    Continuum of Care: Positioning of the Virtual Hospital
    Frontiers Media SA ; 2022
    In:  Frontiers in Cardiovascular Medicine Vol. 8 ( 2022-3-15)
    Details
    In: Frontiers in Cardiovascular Medicine, Frontiers Media SA, Vol. 8 ( 2022-3-15)
    Abstract: Patients with multiple chronic diseases suffer from reduced life expectancy. Care for these patients is often divided over multiple healthcare professionals. eHealth might help to integrate care for these patients and create a continuum. It is the primary purpose of this paper to describe an intervention that integrates first, second, and third line care in patients with multiple chronic conditions using remote monitoring, remote therapy and data automatization, all integrated in a virtual care center (VCC). Methods Patients diagnosed with three or more chronic conditions are included and given smartphone compatible devices for remote monitoring and a tablet for video consultations. Patients will be followed-up by the VCC, consisting of nurses who will coordinate care, supervised by general practitioners and medical specialists. Data is reviewed on a daily basis and patients are contacted on a weekly basis. Review of data is automated by computer algorithms. Patients are contacted in case of outcome abnormalities in the data. Patients can contact the VCC at any time. Follow-up of the study is 1 year. Results The primary outcome of this study is the median number of nights admitted to the hospital per patient compared to the hospitalization data 12 months before enrolment. Secondary outcomes include all-cause mortality, event free survival, quality of life and satisfaction with technology and care. Conclusion This study presents the concept of a VCC that integrates first, second, and third line care into a virtual ward using remote monitoring and video consultation.
    Type of Medium: Online Resource
    ISSN: 2297-055X
    URL: Article
    DOI: 10.3389/fcvm.2021.779075
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2022
    detail.hit.zdb_id: 2781496-8
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  • 10
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    Agreement on fixation of pediatric supracondylar humerus fractures
    Springer Science and Business Media LLC ; 2022
    In:  European Journal of Trauma and Emergency Surgery Vol. 48, No. 5 ( 2022-10), p. 4277-4282
    Details
    In: European Journal of Trauma and Emergency Surgery, Springer Science and Business Media LLC, Vol. 48, No. 5 ( 2022-10), p. 4277-4282
    Type of Medium: Online Resource
    ISSN: 1863-9933 , 1863-9941
    URL: Article
    DOI: 10.1007/s00068-022-01970-7
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2276432-X
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