Should more hospitals in the Netherlands provide PCI without on-site cardiac surgery?

Do patients choose hospitals with high quality ratings? Empirical evidence from the market for angioplasty in the Netherlands

“…In the Netherlands, hospitals are reasonably well reimbursed for PCI procedures(Zijlstra and de Boer, 2007), supply regulation by the government protects the incumbent PCI hospitals against entry of new competitors, and all hospitals are not-for-profit by law.…”

Expansion of off-site percutaneous coronary intervention centres significantly reduces ambulance driving time to primary PCI in the Netherlands

“…Ten years ago, the expansion of off-site primary PCI centres in the Netherlands sparked reactions, from both supporters and opponents [ 25 , 26 ]. Our results showed off-site PCI centres improve accessibility to PCI care.…”

STEMI time delays: a clinical perspective

“… High versus low volume centres: volume and outcome may translate into different outcomes and sicker patients may be presented more often to large volume centres [ 5 , 6 ]. Operator skills, mode of vascular access (femoral versus radial route), procedural time, availability of advanced technology and surgical stand-by may all play an important role and are usually not included as a variable, when it comes to comparison of outcome [ 12 ]. Despite the shortest time delay, patients with out-of-hospital cardiac arrest (OHCA) have the highest mortality [ 19 ].…”

“…Operator skills, mode of vascular access (femoral versus radial route), procedural time, availability of advanced technology and surgical stand-by may all play an important role and are usually not included as a variable, when it comes to comparison of outcome [ 12 ].…”

“…If timely PCI cannot be accomplished, fibrinolytic therapy should be considered but there still is a large debate on the time delay that is acceptable, before deciding for this option, or when a combination of the two reperfusion modalities should be preferred [ 9 – 11 ]. In daily practice in the Netherlands, practically all STEMI patients can be transported to a dedicated PCI catheterisation lab within 60 min after first medical contact (FMC), usually the time of the emergency call [ 8 , 12 ]. In this issue of the journal, Verweij et al try to compare data on time delays and timing of intervention in different hospital settings in the Netherlands and their conclusion is that a lot of data are inconsistent and/or incomplete or even missing or incorrect [ 13 ].…”