Papers by E. Van Der Velde
Driving restrictions after implantable cardioverter defibrillator implantation: an evidence-based... more Driving restrictions after implantable cardioverter defibrillator implantation: an evidence-based approach
T elemedicina predstavlja primjenu napredne telekomunikacijske tehnologije za dijagnostiku, nadzo... more T elemedicina predstavlja primjenu napredne telekomunikacijske tehnologije za dijagnostiku, nadzor i u terapijske svrhe, a moæe se koristiti u gotovo svakoj subspecijalizaciji. Telekardiologija je jedna od najrazvijenijih medicinskih disciplina koju pokriva telemedicina. Telekardiologija je krajnje nastojanje da se tehnologija ujedini s kardiologijom, kako bi pacijenti dobili odgovarajuÊe i toËne savjete i medicinsku skrb bez prekidanja njihove dnevne rutine, a da se u isto vrijeme sve potrebne informacije, πto je prije moguÊe, uËine dostupnima kardiolozima konzultantima. Na taj se naËin smanjuje teret kliniËkih posjeta i nepotrebnih hospitalizacija u optereÊenom zdravstvenom sustavu. Uz pruæanje skrbi za pacijente s bolesti srca, telekardiologija ima kljuËnu ulogu u educiranju tih pacijenata o prirodi njihovog stanja, poboljπavajuÊi njihovu suradljivost pri farmakoloπkoj terapiji te usmjeravajuÊi pacijente zdravim æivotnim navikama. Dobrobit telekardiologije u ruralnim zajednicama ...
JMIR Cardio, 2021
Background Mobile health (mHealth) is an emerging field of scientific interest worldwide. Potenti... more Background Mobile health (mHealth) is an emerging field of scientific interest worldwide. Potential benefits include increased patient engagement, improved clinical outcomes, and reduced health care costs. However, mHealth is often studied in projects or trials, and structural implantation in clinical practice is less common. Objective The purpose of this paper is to outline the design of the Box and its implementation and use in an outpatient clinic setting. The impact on logistical outcomes and patient and provider satisfaction is discussed. Methods In 2016, an mHealth care track including smartphone-compatible devices, named the Box, was implemented in the cardiology department of a tertiary medical center in the Netherlands. Patients with myocardial infarction, rhythm disorders, cardiac surgery, heart failure, and congenital heart disease received devices to measure daily weight, blood pressure, heart rate, temperature, and oxygen saturation. In addition, professional and patien...
JAMA Network Open, 2020
IMPORTANCE Smart technology via smartphone-compatible devices might improve blood pressure (BP) r... more IMPORTANCE Smart technology via smartphone-compatible devices might improve blood pressure (BP) regulation in patients after myocardial infarction. OBJECTIVES To investigate whether smart technology in clinical practice can improve BP regulation and to evaluate the feasibility of such an intervention. DESIGN, SETTING, AND PARTICIPANTS This study was an investigator-initiated, single-center, nonblinded, feasibility, randomized clinical trial conducted at the Department of Cardiology of the Leiden University Medical Center between May 2016 and December 2018. Two hundred patients, who were admitted with either ST-segment elevation myocardial infarction or non-ST-segment acute coronary syndrome, were randomized in a 1:1 fashion between follow-up groups using smart technology and regular care. Statistical analysis was performed from January 2019 to March 2019. INTERVENTIONS For patients randomized to regular care, 4 physical outpatient clinic visits were scheduled in the year following the initial event. In the intervention group, patients were given 4 smartphone-compatible devices (weight scale, BP monitor, rhythm monitor, and step counter). In addition, 2 in-person outpatient clinic visits were replaced by electronic visits. MAIN OUTCOMES AND MEASURES The primary outcome was BP control. Secondary outcomes, as a parameter of feasibility, included patient satisfaction (general questionnaire and smart technology-specific questionnaire), measurement adherence, all-cause mortality, and hospitalizations for nonfatal adverse cardiac events. RESULTS In total, 200 patients (median age, 59.7 years [interquartile range, 52.9-65.6 years]; 156 men [78%]) were included, of whom 100 were randomized to the intervention group and 100 to the control group. After 1 year, 79% of patients in the intervention group had controlled BP vs 76% of patients in the control group (P = .64). General satisfaction with care was the same between groups (mean [SD] scores, 82.6 [14.1] vs 82.0 [15.1]; P = .88). The all-cause mortality rate was 2% in both groups (P > .99). A total of 20 hospitalizations for nonfatal adverse cardiac events occurred (8 in the intervention group and 12 in the control group). Of all patients, 32% sent in measurements each week, with 63% sending data for more than 80% of the weeks they participated in the trial. In the intervention group only, 90.3% of patients were satisfied with the smart technology intervention. CONCLUSIONS AND RELEVANCE These findings suggest that smart technology yields similar percentages of patients with regulated BP compared with the standard of care. Such an intervention (continued) Key Points Question Does the use of smartphone Author affiliations and article information are listed at the end of this article.
JMIR Cardio, 2019
Background: Polysomnography is the gold standard for detection of central sleep apnea in patients... more Background: Polysomnography is the gold standard for detection of central sleep apnea in patients with stable heart failure. However, this procedure is costly, time consuming, and a burden to the patient and therefore unsuitable as a screening method. An electronic health (eHealth) app to measure overnight oximetry may be an acceptable screening alternative, as it can be automatically analyzed and is less burdensome to patients. Objective: This study aimed to assess whether overnight pulse oximetry using a smartphone-compatible oximeter can be used to detect central sleep apnea in a population with stable heart failure. Methods: A total of 26 patients with stable heart failure underwent one night of both a polygraph examination and overnight saturation using a smartphone-compatible oximeter. The primary endpoint was agreement between the oxygen desaturation index (ODI) above or below 15 on the smartphone-compatible oximeter and the diagnosis of the polygraph. Results: The median age of patients was 66.4 (interquartile range, 62-71) years and 92% were men. The median body mass index was 27.1 (interquartile range, 24.4-30.8) kg/m 2. Two patients were excluded due to incomplete data, and two other patients were excluded because they could not use a smartphone. Seven patients had central sleep apnea, and 6 patients had obstructive sleep apnea. Of the 7 (of 22, 32%) patients with central sleep apnea that were included in the analysis, 3 (13%) had an ODI≥15. Of all patients without central sleep apnea, 8 (36%) had an ODI<15. The McNemar test yielded a P value of .55. Conclusions: Oxygen desaturation measured by this smartphone-compatible oximeter is a weak predictor of central sleep apnea in patients with stable heart failure.
The American Journal of Cardiology, 2019
Left ventricular (LV) global longitudinal strain (GLS) can detect subclinical myocardial systolic... more Left ventricular (LV) global longitudinal strain (GLS) can detect subclinical myocardial systolic dysfunction in individuals with diabetes. The present study investigates the clinical usefulness and incremental net benefit of identifying subclinical myocardial systolic dysfunction in individuals with diabetes. A cohort of 397 type 2 diabetic individuals was followed up for the occurrence of all-cause mortality. Clinical and echocardiographic data of diabetic patients were assessed retrospectively. LV GLS was evaluated on transthoracic echocardiography using speckle tracking imaging. Subclinical LV systolic dysfunction was defined as LV GLS > À17.0% from 104 healthy volunteers recruited from the community. A total of 178 (44.8%) diabetic individuals had evidence of subclinical LV systolic dysfunction and 46 (11.6%) died during follow-up. The presence of subclinical LV systolic dysfunction was independently associated with all-cause mortality on follow-up (hazard ratio [HR] 2.83, 95% confidence interval [CI] 1.40 to 5.71, p = 0.004). Diabetic individuals without subclinical LV systolic dysfunction had similar survival as the general population (standardized mortality ratio 0.94, 95% CI 0.52 to 1.58). Decision curve analysis showed identification of subclinical LV systolic dysfunction and quantification of LV GLS provided an incremental net clinical benefit at risk stratifying patients for risk of death at 5 years. In conclusion, subclinical LV systolic dysfunction is independently associated with all-cause mortality in diabetic patients. Decision curve analyses suggest use of LV GLS and identification of subclinical LV systolic dysfunction is clinically useful, and provided incremental net clinical benefit for diabetic individuals.
Expert Review of Medical Devices, 2018
Introduction: Medication adherence is of key importance in the treatment of cardiovascular diseas... more Introduction: Medication adherence is of key importance in the treatment of cardiovascular disease. Studies consistently show that a substantial proportion of patients is non-adherent. Areas covered: For this review, telemedicine solutions that can potentially improve medication adherence in patients with cardiovascular disease were reviewed. A total of 475 PubMed papers were reviewed, of which 74 were assessed. Expert commentary: Papers showed that evidence regarding telemedicine solutions is mostly conflictive. Simple SMS reminders might work for patients who do not take their medication because of forgetfulness. Educational interventions and coaching interventions, primarily delivered by telephone or via a web-based platform can be effective tools to enhance medication adherence. Finally, it should be noted that current developments in software engineering may dramatically change the way nonadherence is addressed in the nearby future.
European Heart Journal, 2017
Transcatheter aortic valve replacement (TAVR) has been shown safe and feasible in patients with b... more Transcatheter aortic valve replacement (TAVR) has been shown safe and feasible in patients with bicuspid aortic valve (BAV) morphology. Evaluation of inter-ethnic differences in valve morphology and function and aortic root dimensions in patients with BAV is important for the worldwide spread of this therapy in this subgroup of patients. Comparisons between large European and Asian cohorts of patients with BAV have not been performed, and potential differences between populations may have important implications for TAVR.
European Journal of Preventive Cardiology, 2016
Demographic changes, progress in medicine technology and regional problems in providing healthcar... more Demographic changes, progress in medicine technology and regional problems in providing healthcare to low density populations are posing great challenges to our healthcare systems. Rapid progress in computer sciences and information technologies have a great impact on the way healthcare will be delivered in the near future. This article describes opportunities and challenges of eHealth and telemedicine in the framework of our health systems and, in particular, in the context of today's cardiology services. The most promising applications of eHealth and telemedicine include: (a) prevention and lifestyle interventions; (b) chronic disease management including hypertension, diabetes and heart failure; (c) arrhythmia detection including early detection of atrial fibrillation and telemonitoring of devices such as pacemaker, internal cardioverter defibrillators and implantable rhythm monitoring devices; (d) telerehabilitation. Major obstacles to the integration of eHealth and telemedicine into daily clinical practice include limited large-scale evidence, in particular, for cost-effectiveness, as well as lack of interoperability, inadequate or fragmented legal frameworks and lack of reimbursement. An important challenge for those involved in these new technologies will be to keep the main focus on patient's individual needs and to carefully evaluate the evidence behind the practice.
European Journal of Preventive Cardiology, 2017
Background: Young patients with congenital heart disease reaching adulthood face mandatory transi... more Background: Young patients with congenital heart disease reaching adulthood face mandatory transition to adult cardiology. Their new cardiologist needs to assess the chances of major future events such as surgery. Using a large national registry, we assessed if patient characteristics at the age of 18 years could predict the chance of congenital heart surgery in adulthood. Design and methods: Of 10,300 patients from the CONCOR national registry, we used general patient characteristics at age 18 years, underlying congenital heart defect, history of complications, and interventions in childhood as potential predictors of congenital heart surgery occurring from age 18 years up to age 40 and 60 years. Cox regression was used to calculate hazard ratios with 95% confidence intervals. Analyses were performed separately for all congenital heart surgery and for valvular surgery alone. Results: Altogether 2427 patients underwent congenital heart surgery after age 18 years, 1389 of whom underwent valvular surgery. Underlying heart defect, male sex, multiple defects, childhood endocarditis, supraventricular arrhythmia, aortic complications and paediatric cardiovascular surgery, independently predicted adult congenital heart surgery. The mean chance of congenital heart surgery was 22% up to age 40 and 43% up to age 60 years; individual chances spanned from 9-68% up to age 40 and from 19-93% up to age 60 years. Conclusion: At the time of transition from paediatric to adult cardiology, an easily obtainable set of characteristics of patients with congenital heart disease can meaningfully inform cardiologists about the patient's individual chance of surgery in adulthood. Our findings warrant validation in other cohorts.
Trials, 2017
Background: Recently published randomised clinical trials indicate that prolonged electrocardiom ... more Background: Recently published randomised clinical trials indicate that prolonged electrocardiom (ECG) monitoring might enhance the detection of paroxysmal atrial fibrillation (AF) in cryptogenic stroke or transient ischaemic attack (TIA) patients. A device that might be suitable for prolonged ECG monitoring is a smartphone-compatible ECG device (Kardia Mobile, Alivecor, San Francisco, CA, USA) that allows the patient to record a single-lead ECG without the presence of trained health care staff. The MOBILE-AF trial will investigate the effectiveness of the ECG device for AF detection in patients with cryptogenic stroke or TIA. In this paper, the rationale and design of the MOBILE-AF trial is presented. Methods: For this international, multicentre trial, 200 patients with cryptogenic stroke or TIA will be randomised. One hundred patients will receive the ECG device and will be asked to record their ECG twice daily during a period of 1 year. One hundred patients will receive a 7-day Holter monitor. Discussion: The primary outcome of this study is the percentage of patients in which AF is detected in the first year after the index ischaemic stroke or TIA. Secondary outcomes include markers for AF prediction, orally administered anticoagulation therapy changes, as well as the incidence of recurrent stroke and major bleeds. First results can be expected in mid-2019.
JAMA cardiology, Jan 4, 2017
Little is known about the association between bicuspid aortic valve (BAV) morphologic findings an... more Little is known about the association between bicuspid aortic valve (BAV) morphologic findings and the degree of valvular dysfunction, presence of aortopathy, and complications, including aortic valve surgery, aortic dissection, and all-cause mortality. To investigate the association between BAV morphologic findings (raphe vs nonraphe) and the degree of valve dysfunction, presence of aortopathy, and prognosis (including need for aortic valve surgery, aortic dissection, and all-cause mortality). In this large international multicenter registry of patients with BAV treated at tertiary referral centers, 2118 patients with BAV were evaluated. Patients referred for echocardiography from June 1, 1991, through November 31, 2015, were included in the study. Clinical and echocardiographic data were analyzed retrospectively. The morphologic BAV findings were categorized according to the Sievers and Schmidtke classification. Aortic valve function was divided into normal, regurgitation, or sten...
European heart journal, Jan 24, 2015
The objective of the CLAIR-DB (Cross Linked Advanced Integrated Research Database) project is to ... more The objective of the CLAIR-DB (Cross Linked Advanced Integrated Research Database) project is to create one single, controlled research database for our department (Cardiology) from which all clinical research will be developed. The ProMISe system is used as the underlying database system. The approach: definition of a limited set of database tables; definition of common variables; all variables unambiguously defined (based on international standards and guidelines). All clinical data are automatically imported from our Cardiology Information System (EPD-Vision) into CLAIR-DB. Therefore, all clinical data are directly available from the source, there is no need for retyping data, data are always up-to-date. Research-specific data are entered directly in the CLAIR-DB web interface. To perform statistical analysis, an export from CLAIR-DB (ProMISe) can be made in SPSS format. Results. Data harmonization from 16 existing databases has resulted in one single well defined data set (CLAIR-DB). Existing research databases are now being transferred to Clair-DB. Conclusion. The CLAIR-DB research database will help to facilitate and improve retrospective analysis of standardized clinically acquired data common to several research lines developed within a single department.
Starting February 2006, the departments Cardiology and Thoracic Surgery of the Leiden University ... more Starting February 2006, the departments Cardiology and Thoracic Surgery of the Leiden University Medical Center use a self-developed Electronic Patient Record System: "EPD-Vision". EPD-Vision offers a complete replacement of the patient chart on paper. EPD-Vision provides an overview of all patient information at every moment and at any location. Patient information in other systems is directly available in EPD-Vision (ECG's, echocardiography and cathlab images and data, lab data). The use of EPD-Vision has resulted in a significant improvement in the quality of care for cardiac patients. Substantial savings have been realized in the secretary staff. Various new modules of EPD-Vision are under development, such order management and an on-line appointment system. With the latter, patients can make appointments (e.g. for the outpatient clinic and pacemaker follow-up) through Internet. Also, parts of EPD-Vision will be available via Internet for patients and professionals.
Netherlands Heart Journal, 2012
Remote follow-up of implanted ICDs may offer a solution to the problem of overcrowded outpatient ... more Remote follow-up of implanted ICDs may offer a solution to the problem of overcrowded outpatient clinics. All major device companies have developed a remote follow-up solution. Data obtained from the remote followup systems are stored in a central database system, operated and owned by the device company and accessible for the physician or technician. However, the problem now arises that part of the patient's clinical information is stored in the local electronic health record (EHR) system in the hospital, while another part is only available in the remote monitoring database. This may potentially result in patient safety issues. Ideally all information should become available in the EHR system. IHE (Integrating the Healthcare Enterprise) is an initiative to improve the way computer systems in healthcare share information. To address the requirement of integrating remote monitoring data in the local EHR, the IHE Implantable Device Cardiac Observation (IDCO) profile has been developed. In our hospital, we have implemented the IHE IDCO profile to import data from the remote databases from two device vendors into the departmental Cardiology Information System. Data are exchanged via an HL7/XML communication protocol, as defined in the IHE IDCO profile.
Remote follow-up of implanted ICD's offers a solution to the problem of overcrowded clinics. ... more Remote follow-up of implanted ICD's offers a solution to the problem of overcrowded clinics. All major device companies have developed a remote follow-up solution. Data from the remote follow-up are stored in a central database system, operated by the device company and accessible for the physician. However, the problem now arises that part of the patient's clinical information is stored
Journal of the American College of Cardiology, 2013
Background: Cardiac resynchronization therapy-defibrillator [CRT-D] implantation reduces the risk... more Background: Cardiac resynchronization therapy-defibrillator [CRT-D] implantation reduces the risk of ventricular arrhythmias in patients with left ventricular [LV] reverse remodelling. Some patients show dramatic improvement of LV ejection fraction [LVEF] due to LV reverse remodelling, hereby they outgrow eligibility for ICD. Data on device therapy of these super responders is scarce. methods: All patients who underwent CRT-D implantation at Leiden University Medical Center are included. Patients are divided in subgroups according reduction in LV end-systolic volume [LVESV], 6 months after implantation. Subgroups are: responders (decreased LVESV 15-30%) and super responders (decreased LVESV >30%), remaining patients were excluded. During follow-up ICD therapy is registered. results: During a median follow up of 48±41 months, 522 patients were followed (292 responders, 230 super responders). In 138 (47%) responders and 131 (57%) super responders LVEF was ≥35% after 6 months. The 5 year cumulative incidence of appropriate therapy is 32% (95% 25-38) in responders and 25% (95% 17-33) in super responders (adjusted P=0.04). The 5 year cumulative incidence of appropriate shock is 18% (95% 13-24) and 11% (95% 6-17) in responders and super responders (adjusted P=0.06). conclusions: CRT-D super responders receive significantly less appropriate ICD therapy compared to responders. However, 25% of super responders are treated for a potentially life threatening arrhythmia during follow up.
International Journal of Cardiology, 2011
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Papers by E. Van Der Velde