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Quality control for invasive cardiology: Holland
1St. Antonius Hospital, Nieuwegein, The Netherlands.
Herz
|October 1, 1996
Summary
Dutch quality control for coronary interventions, including percutaneous transluminal coronary angioplasty (PTCA), shows low mortality rates. Guidelines ensure cardiac surgery and interventions are integrated, with PTCA indications largely appropriate.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health Policy
Background:
- No official registry for coronary heart disease treatments exists in the Netherlands.
- Quality control is managed by governmental bodies, the Dutch Society of Cardiology, and health insurers.
- Historical licensing requirements mandated Ministry of Health approval for coronary interventions until 1991.
Purpose of the Study:
- To evaluate the quality control measures and outcomes of coronary interventions in the Netherlands.
- To assess the appropriateness of percutaneous transluminal coronary angioplasty (PTCA) indications.
- To examine the integration of cardiac surgery and interventional cardiology services.
Main Methods:
- Analysis of guidelines from Dutch authorities and professional societies.
- Review of quality survey data from the Dutch Society of Cardiology.
- Examination of health insurer data and the DUCAT-study utilizing RAND criteria.
Main Results:
- PTCA mortality rate is approximately 0.3%, with an infarction rate of 2%.
- Emergency bypass surgery is required in 1.0-1.6% of cases.
- Over 90% of PTCA indications were deemed appropriate based on RAND criteria, with no inappropriate indications found in health insurer data.
Conclusions:
- Current quality control measures and guidelines appear effective in ensuring appropriate and safe coronary interventions.
- Integration of cardiac surgery and interventional cardiology is recommended.
- Governmental efforts to control PTCA center expansion may lead to longer waiting lists.
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