Abstract
The general aim of this thesis was to study heart failure (HF) treatment and advances
in HF therapy in an attempt to further improve the management of HF patients.
First, the quality of medical therapy of Dutch heart failure patients was studied in the national CHECK-HF registry. In this part, new strategies aiming to improve implementation of the heart failure guidelines in daily clinical practice were discussed as well.
Next, the principle of remote monitoring was discussed. This is a concept that aims to monitoring health status remotely, and aims to detect deterioration in timely manner. Monitoring with the CardioMEMS system, which is a small pulmonary artery pressure sensor, seems promising, but data from European randomised clinical trials are missing. In this thesis, the design and results of the Dutch multicenter MONITOR-HF study were presented. In this randomised clinical trial, monitoring of pulmonary artery pressures with the CardioMEMS system on top of usual HF care was compared to usual HF care alone (without CardioMEMS monitoring). We showed that monitoring with the CardioMEMS system resulted in an important improvement in quality of life, and a 44% reduction in heart failure hospital admissions. Our meta-analysis of three large randomised trials further reinforced our findings.
At last, the use of left ventricular assist device (LVAD) therapy was investigated in patients with advanced heart failure, which is a very severe and end-stage form of HF. The effects of age on clinical outcome after LVAD implantation, and gender differences in the utilization and outcomes after LVAD implantation were studied in the multinational European PCHF-VAD registry. We showed that outcomes in older patients were acceptable, and that age alone should not be an exclusion criteria for LVAD therapy. Survival of female LVAD patients was at least as good as in men, but LVAD therapy is possibly underutilized in women.
in HF therapy in an attempt to further improve the management of HF patients.
First, the quality of medical therapy of Dutch heart failure patients was studied in the national CHECK-HF registry. In this part, new strategies aiming to improve implementation of the heart failure guidelines in daily clinical practice were discussed as well.
Next, the principle of remote monitoring was discussed. This is a concept that aims to monitoring health status remotely, and aims to detect deterioration in timely manner. Monitoring with the CardioMEMS system, which is a small pulmonary artery pressure sensor, seems promising, but data from European randomised clinical trials are missing. In this thesis, the design and results of the Dutch multicenter MONITOR-HF study were presented. In this randomised clinical trial, monitoring of pulmonary artery pressures with the CardioMEMS system on top of usual HF care was compared to usual HF care alone (without CardioMEMS monitoring). We showed that monitoring with the CardioMEMS system resulted in an important improvement in quality of life, and a 44% reduction in heart failure hospital admissions. Our meta-analysis of three large randomised trials further reinforced our findings.
At last, the use of left ventricular assist device (LVAD) therapy was investigated in patients with advanced heart failure, which is a very severe and end-stage form of HF. The effects of age on clinical outcome after LVAD implantation, and gender differences in the utilization and outcomes after LVAD implantation were studied in the multinational European PCHF-VAD registry. We showed that outcomes in older patients were acceptable, and that age alone should not be an exclusion criteria for LVAD therapy. Survival of female LVAD patients was at least as good as in men, but LVAD therapy is possibly underutilized in women.
| Original language | English |
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| Award date | 13 Jun 2023 |
| Place of Publication | Rotterdam |
| Print ISBNs | 978-94-6469-360-7 |
| Publication status | Published - 13 Jun 2023 |