ABSTRACT
BACKGROUND: Heart failure (HF) is associated with poor prognosis, high morbidity and mortality. The prognosis can be optimised by guideline adherence, which also can be used as a benchmark of quality of care. The purpose of this study was to evaluate differences in use of HF medication between Dutch HF clinics. METHODS: The current analysis was part of a cross-sectional registry of 10,910 chronic HF patients at 34 Dutch outpatient clinics in the period of 2013 until 2016 (CHECK-HF), and focused on the differences in prescription rates between the participating clinics in patients with heart failure with reduced ejection fraction (HFrEF). RESULTS: A total of 8,360 HFrEF patients were included with a mean age of 72.3⯱ 11.8 years (ranging between 69.1⯱ 11.9 and 76.6⯱ 10.0 between the clinics), 63.9% were men (ranging between 54.3 and 78.1%), 27.3% were in New York Heart Association (NYHA) class III/IV (ranging between 8.8 and 62.1%) and the average estimated glomerular filtration rate (eGFR) was 59.6⯱ 24.6â¯ml/min (ranging between 45.7⯱ 23.5 and 97.1⯱ 16.5). The prescription rates ranged from 58.9-97.4% for beta blockers (pâ¯< 0.01), 61.9-97.1% for renin-angiotensin system (RAS) inhibitors (pâ¯< 0.01), 29.9-86.8% for mineralocorticoid receptor antagonists (MRAs) (pâ¯< 0.01), 0.0-31.3% for ivabradine (pâ¯< 0.01) and 64.9-100.0% for diuretics (pâ¯< 0.01). Also, the percentage of patients who received the target dose differed significantly, 5.9-29.1% for beta blockers (pâ¯< 0.01), 18.4-56.1% for RAS inhibitors (pâ¯< 0.01) and 13.2-60.6% for MRAs (pâ¯< 0.01). CONCLUSIONS: The prescription rates and prescribed dosages of guideline-recommended medication differed significantly between HF outpatient clinics in the Netherlands, not fully explained by differences in patient profiles.
ABSTRACT
BACKGROUND: The focus of the diagnostic process in chest pain patients at the emergency department is to identify both low and high risk patients for an acute coronary syndrome (ACS). The HEART score was designed to facilitate this process. This study is a prospective validation of the HEART score. METHODS: A total of 2440 unselected patients presented with chest pain at the cardiac emergency department of ten participating hospitals in The Netherlands. The HEART score was assessed as soon as the first lab results and ECG were obtained. Primary endpoint was the occurrence of major adverse cardiac events (MACE) within 6 weeks. Secondary endpoints were (i) the occurrence of AMI and death, (ii) ACS and (iii) the performance of a coronary angiogram. The performance of the HEART score was compared with the TIMI and GRACE scores. RESULTS: Low HEART scores (values 0-3) were calculated in 36.4% of the patients. MACE occurred in 1.7%. In patients with HEART scores 4-6, MACE was diagnosed in 16.6%. In patients with high HEART scores (values 7-10), MACE occurred in 50.1%. The c-statistic of the HEART score (0.83) is significantly higher than the c-statistic of TIMI (0.75)and GRACE (0.70) respectively (p<0.0001). CONCLUSION: The HEART score provides the clinician with a quick and reliable predictor of outcome, without computer-required calculating. Low HEART scores (0-3), exclude short-term MACE with >98% certainty. In these patients one might consider reserved policies. In patients with high HEART scores (7-10) the high risk of MACE may indicate more aggressive policies.
Subject(s)
Chest Pain/diagnosis , Coronary Angiography/methods , Electrocardiography , Emergency Service, Hospital , Myocardial Infarction/diagnosis , Risk Assessment/methods , Aged , Chest Pain/epidemiology , Chest Pain/etiology , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Male , Middle Aged , Myocardial Infarction/complications , Myocardial Infarction/epidemiology , Netherlands/epidemiology , Prospective Studies , Risk Factors , Severity of Illness Index , Survival Rate/trendsABSTRACT
Two cases of culture negative endocarditis are presented. In both, Bartonella species could be identified as the causative agent and in one of them Bartonella henselae was very likely. Both cases were accompanied by glomerulonephritis, in one case proven by a kidney biopsy. A nephrotic syndrome may be the first presentation of an endocarditis caused by Bartonella species.
