Aims Non-acute chest pain is a common complaint and can be caused by various conditions. With the rising healthcare expenditures of today, it is necessary to use our healthcare resources... Show moreAims Non-acute chest pain is a common complaint and can be caused by various conditions. With the rising healthcare expenditures of today, it is necessary to use our healthcare resources effectively. This study aims to give insight into the diagnostic effort and costs for patients with non-acute chest pain.Methods and results Financial data of patients without a cardiac history from four hospitals (January 2012-October 2018), who were registered with the national diagnostic code 'no cardiac pathology' (ICD-10 Z13.6), 'chest wall syndrome' (ICD-10 R07.4), or 'stable angina pectoris' (ICD-10 I20.9) were extracted. In total, 74 091 patients were included for analysis and divided into the following final diagnosis groups: no cardiac pathology: N=19 688 (age 5318), 46% male; chest wall syndrome: N=40 858 (age 56 +/- 15), 45% male; and stable angina pectoris (AP): N=13 545 (age 67 +/- 11), 61% male. A total of approximately (sic)142.7 million was spent during diagnostic work-up. The total expenditure during diagnostic effort was (sic)1.97, (sic)8.13, and (sic)10.7 million, respectively for no cardiac pathology, chest wall syndrome, and stable AP per year. After 8years of follow-up, >= 95% of the patients diagnosed with no cardiac pathology or chest wall syndrome had an (cardiac) ischaemic-free survival.Conclusion The diagnostic expenditure and clinical effort to ascertain non-cardiac chest pain are high. We should define what we as society find acceptable as 'assurance costs' with an increasing pressure on the healthcare system and costs. Show less
Despite optimal medical treatment and advanced revascularization strategies, a growing number of patients suffer from severe coronary artery disease not amenable to conventional treatment... Show more Despite optimal medical treatment and advanced revascularization strategies, a growing number of patients suffer from severe coronary artery disease not amenable to conventional treatment options. Bone marrow cell injection has emerged as a new potential therapeutic option for these patients. As preclinical studies provided evidence for improvement in myocardial perfusion and function after transplantation of cells, cell therapy was introduced in the clinical setting. As initial studies demonstrated promising results, intramyocardial injection of autologous bone marrow-derived mononuclear cells emerged as a new therapeutic option for patients with severe coronary artery disease. Although studies demonstrated safety and feasibility of the approach, the overall effect of bone marrow cell treatment has shown moderately positive but variable effects. However, many questions remain whether there are certain factors, such as patient specific characteristics, that influence treatment outcome. Therefore, in the current thesis, the efficacy of bone marrow cell injection was investigated in a large refractory angina patient population with chronic myocardial ischemia to further evaluate treatment effect during short and long term follow-up. In addition, the safety and effect of autologous mesenchymal stem cells injection, a specific bone marrow-derived cell type, in patients shorty after acute myocardial infarction was evaluated. Show less
Measurement of quality of life (QOL) as an indicator of health outcome has become increasingly important in patients with coronary artery disease. Nitrates can effectively control symptoms of... Show moreMeasurement of quality of life (QOL) as an indicator of health outcome has become increasingly important in patients with coronary artery disease. Nitrates can effectively control symptoms of angina. A once daily dosage regimen of isosorbide mononitrate might provide better QOL than conventional multiple daily dosage regimen. To assess this, we performed two studies in patients with angina pectoris. We conclude that replacement of a multiple daily dosage regimen with a once daily dosage regimen results in an improved QOL, anginal NYHA class and exercise capacity. We also conclude that patients with certain cardiac risk factors and co-morbidities might particularly benefit. In a separate chapter we study the influence of pschychological factors on QOL in patients with heart failure and in patients on the waiting list for coronary angiography. Finale we discuss a study concerning early discharge in patients with acute myocardial infarction treated with primary PCI. We conclude that hospital discharge on the day after admission in combination with a rehabilitation program is feasible and offers a safe and patient-friendly alternative to the usual 3 to 4 days of in hospital care, without negative effect on QOL or secondary prevention goals. Show less
