Dutch Heart Registry

Reducing AF-related symptoms and improving health-related quality of life (HRQoL) are important drivers in the decision for pulmonary vein isolation (PVI) in treating symptomatic atrial fibrillation (AF). We assessed the association between various patient characteristics, intervention, and outcome variables, and HRQoL both prior to and one year after PVI, with specific attention to groups that did not improve or were still impaired in HRQoL post PVI. Observational, retrospective multicenter cohort study within 8hospitals participating in the Netherlands Heart Registration (NHR). Patients who underwent PVI between 2016 and 2019 and completed the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire both prior to and one year after were included. Accepted cut-off values for impaired HRQoL and clinically important difference (CID) were used. Mean AFEQT score (n = 2,534) was 55.6 ± 19.7 prior to intervention and 79.8 ± 20.2 after. Post-PVI, 39.5% of the population was still impaired in HRQoL (< 80points), and 19.2% failed to achieve CID (delta ≥ 5points). Lower baseline AFEQT-score (odds ratio [OR], 0.96 [per 1‑point increase]; 95% CI, 0.96-0.97; p < 0.001) and female sex (odds ratio [OR], 1.42; 95% CI, 1.16-1.75; p < 0.001) were the most prominent related factors with impaired HRQoL post-PVI. Higher baseline AFEQT-score (odds ratio [OR], 1.04 [per 1‑point increase]; 95% CI, 1.04-1.05; p < 0.001) was strongly associated with failure to achieve CID. Despite amajor increase in HRQoL across the population, over one-third of patients were still impaired in HRQoL post-PVI. Multiple factors were identified that may guide counselling of AF patients about treatment choice.

Up to half of patients with infective endocarditis (IE) require cardiac surgery. Although anaemia is common, its precise prevalence, transfusion practices and impact on outcomes in surgically treated IE patients remain unclear. Therefore, our aim was to determine the incidence and severity of preoperative anaemia, describe transfusion and coagulation management and evaluate associations of anaemia and red blood cell (RBC) transfusion with mortality, including sex-based differences. This retrospective multicentre cohort study used data from the Netherlands Heart Registration, including all adult patients who underwent valve surgery for active IE between 1 January 2016 and 31 December 2023. Anaemia was defined by WHO criteria. Kaplan-Meier and Cox proportional hazards models were used to evaluate associations between anaemia severity, RBC transfusion and 30-day and 1-year mortality. Multivariable analyses were adjusted for age, sex, prior valve surgery, renal dysfunction, surgery urgency, cardiopulmonary bypass and aortic cross-clamp times, surgical re-exploration, preoperative critical illness, surgical re-exploration and year of surgery. Of 2480 patients, 84.9% had preoperative anaemia (50.7% moderate, 2.8% severe). RBC transfusion occurred in 78.7% of patients. 30-day and 1-year mortality were 10.6% and 16.6%, respectively. Moderate and severe anaemia were associated with higher mortality in univariable, but not in multivariable analysis. RBC transfusion remained independently associated with mortality at both time points (adjusted HR for mortality at 30 days 3.58, 95% CI 2.07 to 6.19). Female patients had higher transfusion rates and mortality. Anaemia and transfusion are highly prevalent in IE surgery and associated with increased mortality. RBC transfusion is an independent predictor of adverse outcomes, underscoring the need for improved anaemia management and individualised transfusion strategies.

PurposeThis study aimed to determine the incidence of postoperative primary total hip arthroplasty (THA) stem revision due to periprosthetic fractures (PPF) and analyze related patient and surgical factors.Materials and MethodsUtilizing the Kaplan–Meier analysis and Cox regression method to identify risk factors for stem revision due to PPF, this study analyzed 331,009 primary THA procedures from the Dutch Arthroplasty Register between 2007 and 2021.ResultsAt 10-year follow-up, the incidence rate was 0.7%. Patient specific factors with significant incidence probabilities were higher age (hazard ratio [HR] 1.29 per 10 years, 95% confidence interval [CI] 1.22-1.36), female sex (HR 1.30, 95% CI 1.16-1.45), American Society of Anesthesiologists (ASA) class II (HR 1.56, 95% CI 1.27-1.93) and ASA class III-IV (HR 2.07, 95% CI 1.59-2.71), Charnley score B2 (HR 1.46, 95% CI 1.23-1.72) and Charnley score C (HR 1.81, 95% CI 1.26-2.59), and higher body mass index (BMI) (HR 1.02 per kg/m2, 95% CI 1.00-1.03). Surgery specific factors with significant incidence probabilities were interventions with an uncemented stem (HR 4.55, 95% CI 3.85-5.26), and anterior approach compared to posterolateral approach (HR 1.25, 95% CI 1.03-1.52).ConclusionThe highest risk of PPF in THA requiring stem revision was found in older female patients with high ASA class, Charnley score and BMI as well as uncemented implants. This result may prompt surgeons to strive for cemented stem fixation in patients with declining bone stock when feasible. Furthermore, care should be taken when using anterior approaches for patients with specific risk factors.

Abstract Background and Aims Chronic Kidney Disease—Mineral and Bone Disorder (CKD-MBD) may both be a cause and a consequence of CKD progression. In the present study, we aim to assess the individual and combined causal effect of longitudinal CKD-MBD biomarkers (PTH, phosphate and calcium) on CKD progression in a European cohort of older patients with CKD stages 4–5 not on dialysis, using G-methods to avoid bias due to informative censoring, competing events, and time-varying confounding. Method We used data from the EQUAL study, which enrolled patients aged ≥65 with advanced CKD (eGFR ≤ 20 ml/min) from six European countries. Associations between various CKD-MBD phenotypes and eGFR decline, the risk of dialysis initiation, accounting for competing risk of death, and the risk of the composite outcome of either dying or starting dialysis were assessed using the g-formula for causal inference. This method fits separate regression models for time-varying exposures, time-varying confounders, outcomes, and the probability of remaining uncensored over time, and then uses these models to simulate the effect of a specified exposure on the outcome, if sustained over time. Results The 1709 patients included in the study had a median baseline eGFR of 17 ml/min (IQR 14–20). During a median time follow up of 2.1 years (IQR 0.9–3.6), 570 patients started dialysis, while 397 died. We found that hyperphosphatemia, hyperparathyroidism and hypocalcemia were associated with a higher risk of CKD progression. Their combination represented the phenotype associated with the highest risk of progression, demonstrating a significant mean difference in eGFR after 3 years (−3.85 ml/min, 95% CI: −5.56, −2.44) and an 80% higher risk of starting dialysis (HR 1.80, 95% CI: 1.40–2.21), compared to having all biomarkers in their reference ranges. Most of this risk can be attributed to hyperphosphatemia, as the phenotype characterized by hyperphosphatemia with PTH and calcium in their reference range showed a mean eGFR difference after 3 years of −2.16 ml/min (95% CI: −3.25, −1.20) and an HR for starting dialysis of 1.37 (95% CI: 1.15, 1.66), whereas the phenotypes of isolated hyperparathyroidism and isolated hypocalcemia had milder effects. The effects of mineral abnormalities were similar between sexes. Conclusion Among older men and women with advanced CKD who are not receiving dialysis, the presence of hyperphosphatemia, hyperparathyroidism, and hypocalcemia is linked to an increased risk of CKD progression, particularly when these conditions are present simultaneously. Using robust methods for causal inference, our study strengthens existing evidence that abnormal mineral biomarkers increase the risk of CKD progression and supports that maintaining CKD-MBD biomarkers in their reference range may slow disease progression and delay dialysis initiation, even in advanced CKD.

BackgroundDespite 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.MethodsTo 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.ResultsThe 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.ConclusionThis 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.

BackgroundPrior to total hip and knee arthroplasty (THA/TKA), patients with low socioeconomic status (SES) report worse Patient-Reported Outcome Measures (PROMs), persisting postoperatively. This study explores which self-reported PROMs and their specific domains are most involved.MethodsWe obtained data from the Dutch Arthroplasty Registry (2014–2022), including over 100,000 THA/TKA patients with complete preoperative and 12-month follow-up PROMs. The EQ-5D-3L and EQ-5D-5L, EQ Visual Analogue Scale (VAS), Oxford Hip and Oxford Knee Score (OHS/OKS), and Numerical Rating Scales (NRS) for pain and satisfaction (TKA only, at 12-month follow-up) were obtained. The PROMs were transformed to a 0-100 scale for direct comparison. A SES-indicator based on neighborhood income, unemployment rate, and education level was divided into quintiles, which are equal groups representing 20% of the Dutch population, and was ranked from least to most deprived. Through linear regression we contrasted the most and least deprived groups, adjusting for patient and surgical characteristics. The contribution (percentage) of each domain to the overall health inequalities was estimated for the EQ-5D’s and the OHS/OKS.ResultsIn TKA patients, the most compared to the least deprived group had a lower preoperative EQ-5D-3L score: -2.1 [95% confidence interval − 2.6, -1.6], p < 0.001. At 12-month follow-up, the difference was smaller: EQ-5D-3L 1.3 [-1.9, -0.7], p < 0.001. A larger difference between the most and least deprived was present in OKS (preoperatively: -4.3 [-5.3, -3.4], p < 0.001; 12-month: -1.8 [-2.5, -1.2], p < 0.001). The difference in EQ VAS was smaller (preoperatively: -0.8 [-1.5, -0.1], p = 0.024; 12-month: -0.5 [-1.2, 0.1], p = 0.108). The difference in NRS pain (in rest) was comparable to those in EQ-5D-3L and OKS (preoperatively: -4.5 [-5.4, -3.5], p < 0.001; 12-month: -2.7 [-3.5, -1.9], p < 0.001), while no difference between the most and least deprived in NRS satisfaction was observed at 12 months. For EQ-5D-3L, the domain usual activities accounted for up to 46% of the difference between SES groups, while anxiety/depression played a limited role (up to 17%). For OHS/OKS, functioning contributed most in THA (up to 61%) and pain contributed most in TKA (up to 68%). Differences in PROM scores between SES groups, and how these differences compared across PROMs, were similar in THA patients. Overall, the EQ-5D-5L produced similar patterns compared to the EQ-5D-3L.ConclusionsDeprived THA/TKA patients have poorer pre- and postoperative health, which was primarily related to worse functioning and pain; the clinical relevance of these differences remain uncertain. These differences did not translate into worse overall health (EQ VAS) or into higher dissatisfaction among deprived patients. Future research should investigate whether the EQ VAS and satisfaction measure reflected health differences between SES groups or were biased by reporting heterogeneity, where respondents interpreted the wording differently.

This paper aims to evaluate the relationship between microplastic abundance and plankton species diversity. Microplastics, as a new and increasingly disturbing pollutant, can affect the quality of aquatic ecosystems, including plankton communities. Water samples were taken from several points in Kwatisore waters to measure microplastic concentrations, as well as to identify and count the types of plankton present. The results of the analysis will later show that there is a negative relationship between the abundance of microplastics and the diversity of plankton types. An increase in microplastic concentrations is associated with a decrease in the amount and diversity of plankton, which can impact the stability of aquatic ecosystems. These findings underscore the importance of managing and mitigating plastic pollution to maintain healthy aquatic ecosystems. Further research is needed to understand the impact mechanisms of microplastics in more depth and to develop effective conservation strategies.

OBJECTIVESTo describe the nationwide survival outcomes after surgery for type A aortic dissection.METHODSAll patients who underwent surgery for type A aortic dissection in the Netherlands between 2018 and 2021 were identified in the Netherlands Heart Registration (NHR) database. The NHR data were linked to lifelong survival data from Statistics Netherlands (98% match). Time trends for in-hospital and mid-term mortality were described, and age- and sex-adjusted regression analysis was performed. The cause and location of death were reported and stratified according to survival time intervals.RESULTSThe study population consisted of 1317 patients with a mean age of 63.1 years (11.8). The number of surgeries increased from 284 in 2018 to 375 in 2021. The surgery included the ascending aorta in 99%, aortic arch in 73%, aortic root in 32.5% and the descending aorta in 5% of cases. In-hospital mortality decreased from 20.4% in 2018 to 13.9% (95% CI: [10.4%, 17.4%]) in 2021. A total of 318 deaths were recorded, and the majority (70%) of patients died from the consequences of their dissection. However, among 365-day survivors, only 14% died related to their dissection, while 37% of deaths were related to cardiovascular disease and 17% to cancer. The majority (84%) of patients died in the hospital, but deaths after 365 days occurred most frequently (37%) at home.CONCLUSIONSOver the recent years, the number of surgeries for type A dissections in the Netherlands has increased, and in-hospital mortality has decreased. For patients surviving 1 year after surgery, the main cause of death was not dissection, but other causes such as cardiovascular disease or cancer.

Controversies exist regarding sex differences in outcomes after coronary artery bypass grafting (CABG). This study assessed sex differences in early and mid-term outcomes after CABG and factors associated with these differences. Outcomes were based on data from the Netherlands Heart Registration (NHR). Data of patients undergoing CABG in the Netherlands between 2013 and 2019 were retrieved from the NHR database. Primary outcomes were early mortality, morbidity and mid-term survival. The population was divided into subgroups based on age (≥ 70years and < 70years). Regression analyses investigated the correlation between sex and both early and mid-term mortality. This study included 41,705 male and 10,048 female patients. Median follow-up was 3.6 (1.8-4.8) years. Female patients were less likely to receive ≥ 2 arterial grafts (15.9% vs 23.2%, p < 0.001), had fewer anastomoses (3.2 ± 1.1 vs 3.5 ± 1.1, p < 0.001), higher 30-day mortality (1.9% vs 1.0%; p < 0.001) and alower mid-term survival rate (91.3% vs 93.1%, p < 0.001). Perioperative complications, including myocardial infarction and stroke, were more common in female patients (all p < 0.001). Women aged < 70years had alower mid-term survival rate than men < 70years (94.5% vs 96.0%, p < 0.001). Cox regression analysis showed that female sex was not significantly associated with mid-term mortality in the total cohort [hazard ratio (HR) 1.03; p = 0.45] but was associated with mid-term mortality in patients aged < 70years (HR 1.19; p < 0.001). Women undergoing CABG in our cohort presented with more complex risk profiles, received different surgical strategies and had worse early and mid-term outcomes compared to men. Female sex was associated with mid-term mortality only in patients < 70years of age.

Abstract Introduction Inotropes and vasopressors (inopressors) are commonly used in the treatment of acute myocardial infarction complicated by cardiogenic shock (AMICS). The characteristics of patients subjected to early or late initiation of inopressors are not yet described, and the impact of timing on outcomes remains uncertain. Purpose This retrospective real-world data study aims to identify patient-, treatment-, and outcome characteristics of AMICS patients treated with early- or late initiated inopressors. Methods The Netherlands Heart Registration (NHR) prospectively records baseline, procedural, and outcome data for PCI patients. Between 2017-2021, additional retrospective data on CS patients were collected by fourteen Dutch hospitals. Patients were categorized based on the timing of inopressor initiation, either early (pre PCI) or solely late (at the cathlab or within 24 hours after PCI). Patients presenting with an out of hospital cardiac arrest were excluded. Missing data were imputed through multiple imputation (30x). Multivariable logistic regression analysis was performed to evaluate the association between the timing of inopressor initiation and 30-day mortality, adjusting for univariate significant confounders among variables known at admission. Results A total of 956 consecutive CS patients were included of whom 418 (43.7%) and 538 (57.3%) patients were subjected to early and late initiation of inopressors respectively. The most frequently used drug in both groups was noradrenaline. At baseline, patients in the early initiation group were younger (67.4 vs. 70.0 years, p &amp;lt;0.001), presented with a lower mean arterial pressure (MAP) (72.5 vs. 76.3, p = 0.048) and higher lactate (4.2 vs. 3.6, p = 0.012), and presented with a NSTEMI more often (36.0% vs. 14.2%, p &amp;lt;0.001). They also had a higher prevalence of previous myocardial infarction (33.9% vs. 22.9%, p &amp;lt;0.001) and previous CABG (14.3% vs. 6.2%, p &amp;lt;0.001). Moreover, 30-day mortality rates were higher in the early initiated group (48.6% vs. 37.6%, pLogrank &amp;lt;0.001). After multivariate adjustment for age, admission MAP and lactate, early inopressor initiation remained independently associated with 30-day mortality (OR 1.44, 95%-CI 1.08-1.98) compared to late initiation. Conclusion In this Dutch cohort of CS patients undergoing PCI, baseline- treatment- and outcome characteristics differed between patient categories receiving either early or late initiated inopressors. Patients who were subjected to early initiated inopressors were younger, presented with worse hemodynamics, had a more extensive cardiovascular medical history and higher 30-day mortality rates. The results of this study reemphasize the importance of identifying patients who benefit from inopressors.30-day mortality late vs. earlyTable patient characteristics