Bijzondere interventies aan het hart - Gezondheidsraad

as more elderly age groups experience a higher incidence of symptoms of cardiovascular
disease. In addition, there is an increasing incidence of specific disorders,
such as diabetes mellitus, which in turn further exacerbate the risk of
cardiovascular diseases. On the other hand, the increased number of interventions
for cardiovascular disease is also a result of the expanded range and
increasing success of therapeutic options, particularly in the past ten years. This
has enabled greater numbers of elderly patients and patients with additional diseases
(comorbidity) to be treated more prudently and effectively. There was also
an increase in the range of technical options available, as witnessed by the development
of the implantable cardioverter defibrillator (ICD), the cardiac resynchronisation
therapy pacemaker (CRT-P), and the use of systems designed to
partially or completely replace the pumping function of the heart (ventricular
assist devices). In addition, the timing of the intervention has shifted. These days,
it is much more likely to take place at an earlier stage in the disease process.
There is also a much greater focus on opportunities for improving the quality of
the period of life remaining to individuals with heart disease. This applies, for
instance, to patients in the final stages of chronic heart failure.
This increase in the number of patients with cardiovascular diseases and in
the range of treatment options available to them demands an unremitting focus
on expanding the number of specialised treatment centres. The central pillars in
all of this are quality, efficiency, and accessibility.
2 Patient safety and treatment quality: a national registration system
The practice of specialised and relatively expensive forms of medicine such as
open heart surgery, interventional cardiology, and the treatment of cardiac
arrhythmias and congenital disorders, demands a sharply focused quality assurance
policy. Accordingly, treatment centres will have to comply with certain
minimum requirements regarding the number of qualified therapists, the available
infrastructure, and an annual number of procedures that is consistent with a
prudent approach to the work in hand. Individual professionals are expected to
keep their qualifications for their healthcare duties current, by means of training,
refresher courses, and by updating their skills. In the case of individual centres,
every aspect of quality must be assessed by means of periodic external reviews.
This type of quality control has already been introduced into the Netherlands.
However, the Netherlands still lacks a national registration system for data
from all cardiac surgery centres and Percutaneous Coronary Intervention (PCI)
centres. A registration system of this kind would make the treatment results per
centre and per individual therapist more transparent. It would also enable these
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