Progress in heart failure management in the Netherlands and beyond: long-term commitment to deliver high-quality research and patient care

Meems, L. M. G.; Veldhuisen, Dirk J. van; Boer, Rudolf A. de

doi:10.1007/s12471-020-01453-7

Cited by 5 publications

(5 citation statements)

References 60 publications

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“… 20 , 21 To ensure systematic and coordinated treatments, DMPs for HF have been implemented on a national level. 22 These cover care in hospitals, outpatient clinics or at home. 23 , 24 More recently, the Connect programme aims at implementing agreements across primary, secondary and tertiary care at regional levels to improve HF-care.…”

Section: Resultsmentioning

confidence: 99%

Challenges in heart failure care in four European countries: a comparative study

Steiner,

Neumann,

Pelz

et al. 2023

European Journal of Public Health

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Background In Europe, more than 15 million people live with heart failure (HF). It imposes an enormous social, organizational and economic burden. As a reaction to impending impact on healthcare provision, different country-specific structures for HF-care have been established. The aim of this report is to provide an overview and compare the HF-care approaches of Germany, Ireland, the Netherlands and the UK, and to open the possibility of learning from each other’s experience. Methods A mixed methods approach was implemented that included a literature analysis, interviews and questionnaires with HF-patients and caregivers, and expert interviews with representatives from healthcare, health service research and medical informatics. Results The models of HF-care in all countries analyzed are based on the European Society of Cardiology guidelines for diagnosis and treatment of HF. Even though the HF-models differed in design and implementation in practice, key challenges were similar: (i) unequal distribution of care between urban and rural areas, (ii) long waiting times, (iii) unequal access to and provision of healthcare services, (iv) information and communication gaps and (v) inadequate implementation and financing of digital applications. Conclusion Although promising approaches exist to structure and improve HF-care, across the four countries, implementation was reluctant to embrace novel methods. A lack of financial resources and insufficient digitalization making it difficult to adopt new concepts. Integration of HF-nurses seems to be an effective way of improving current models of HF-care. Digital solutions offer further opportunities to overcome communication and coordination gaps and to strengthen self-management skills.

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Section: Resultsmentioning

confidence: 99%

Challenges in heart failure care in four European countries: a comparative study

Steiner,

Neumann,

Pelz

et al. 2023

European Journal of Public Health

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“…Within cardiology, previous research has shown that there are meaningful differences between the sexes in clinical characteristics and therapeutic responses to different treatments [ 35 ]. A possible explanation for the difference is the higher prevalence of HF with preserved ejection fraction (HF-pEF) among female patients, which has limited treatment options compared to HF with reduced ejection fraction (HF-rEF) [ 36 ]. Fewer medical treatment options may translate into less need for remote monitoring of titration of medication [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Characteristics Associated With Telemonitoring Use Among Patients With Chronic Heart Failure: Retrospective Cohort Study

Auener,

van Dulmen,

Atsma

et al. 2023

J Med Internet Res

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Background Chronic heart failure (HF) is a chronic disease affecting more than 64 million people worldwide, with an increasing prevalence and a high burden on individual patients and society. Telemonitoring may be able to mitigate some of this burden by increasing self-management and preventing use of the health care system. However, it is unknown to what degree telemonitoring has been adopted by hospitals and if the use of telemonitoring is associated with certain patient characteristics. Insight into the dissemination of this technology among hospitals and patients may inform strategies for further adoption. Objective We aimed to explore the use of telemonitoring among hospitals in the Netherlands and to identify patient characteristics associated with the use of telemonitoring for HF. Methods We performed a retrospective cohort study based on routinely collected health care claim data in the Netherlands. Descriptive analyses were used to gain insight in the adoption of telemonitoring for HF among hospitals in 2019. We used logistic multiple regression analyses to explore the associations between patient characteristics and telemonitoring use. Results Less than half (31/84, 37%) of all included hospitals had claims for telemonitoring, and 20% (17/84) of hospitals had more than 10 patients with telemonitoring claims. Within these 17 hospitals, a total of 7040 patients were treated for HF in 2019, of whom 5.8% (409/7040) incurred a telemonitoring claim. Odds ratios (ORs) for using telemonitoring were higher for male patients (adjusted OR 1.90, 95% CI 1.50-2.41) and patients with previous hospital treatment for HF (adjusted OR 1.76, 95% CI 1.39-2.24). ORs were lower for higher age categories and were lowest for the highest age category, that is, patients older than 80 years (OR 0.30, 95% CI 0.21-0.44) compared to the reference age category (18-59 years). Socioeconomic status, degree of multimorbidity, and excessive polypharmacy were not associated with the use of telemonitoring. Conclusions The use of reimbursed telemonitoring for HF was limited up to 2019, and our results suggest that large variation exists among hospitals. A lack of adoption is therefore not only due to a lack of diffusion among hospitals but also due to a lack of scaling up within hospitals that already deploy telemonitoring. Future studies should therefore focus on both kinds of adoption and how to facilitate these processes. Older patients, female patients, and patients with no previous hospital treatment for HF were less likely to use telemonitoring for HF. This shows that some patient groups are not served as much by telemonitoring as other patient groups. The underlying mechanism of the reported associations should be identified in order to gain a deeper understanding of telemonitoring use among different patient groups.

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“…Despite therapeutic advances and ongoing research, advanced heart failure remains associated with frequent hospital admissions, poor prognosis and high costs [1][2][3]. As patients with advanced heart failure often suffer pronounced functional decline and poor quality of life, they could benefit from palliative care [4].…”

Section: Introductionmentioning

confidence: 99%

A pilot study on the effect of advance care planning implementation on healthcare utilisation and satisfaction in patients with advanced heart failure

Coster

Maat

Pentinga³

et al. 2022

Neth Heart J

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Background Patients with advanced heart failure may benefit from palliative care, including advance care planning (ACP). ACP, which can include referral back to the general practitioner (GP), may prevent unbeneficial hospital admissions and interventional/surgical procedures that are not in accordance with the patient’s personal goals of care. Aim To implement ACP in patients with advanced heart failure and explore the effect of ACP on healthcare utilisation as well as the satisfaction of patients and cardiologists. Methods In this pilot study, we enrolled 30 patients with New York Heart Association class III/IV heart failure who had had at least one unplanned hospital admission in the previous year because of heart failure. A structured ACP conversation was held and documented by the treating physician. Primary outcome was the number of visits to the emergency department and/or admissions within 3 months after the ACP conversation. Secondary endpoints were the satisfaction of patients and cardiologists as established by using a five-point Likert scale. Results Median age of the patients was 81 years (range 33–94). Twenty-seven ACP documents could be analysed (90%). Twenty-one patients (78%) did not want to be readmitted to the hospital and subsequently none of them were readmitted during follow-up. Twenty-two patients (81%) discontinued all hospital care. All patients who died during follow-up (n = 12, 40%) died at home. Most patients and cardiologists indicated that they would recommend the intervention to others (80% and 92% respectively). Conclusion ACP, and subsequent out-of-hospital care by the GP, was shown to be applicable in the present study of patients with advanced heart failure and evident palliative care needs. Patients and cardiologists were satisfied with this intervention.

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Progress in heart failure management in the Netherlands and beyond: long-term commitment to deliver high-quality research and patient care

Cited by 5 publications

References 60 publications

Challenges in heart failure care in four European countries: a comparative study

Challenges in heart failure care in four European countries: a comparative study

Characteristics Associated With Telemonitoring Use Among Patients With Chronic Heart Failure: Retrospective Cohort Study

A pilot study on the effect of advance care planning implementation on healthcare utilisation and satisfaction in patients with advanced heart failure

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