This thesis evaluated the efficacy of elective abdominal aortic aneurysm repair. The first part of this thesis evaluated the presumed long-term survival differences of endovascular aneurysm repair ... Show moreThis thesis evaluated the efficacy of elective abdominal aortic aneurysm repair. The first part of this thesis evaluated the presumed long-term survival differences of endovascular aneurysm repair (EVAR) versus open repair. Thereby, it evaluated the impact of developments in AAA management (i.e. the introduction of EVAR and cardiovascular risk management) on the long-term life-expectancy after repair. The second part of this thesis focused on other outcomes important in the evaluation of AAA care. It evaluated the presumed long-term cost difference of EVAR and open repair. In addition, it investigated how the patient perspective is currently embedded in AAA research.The five main conclusions of this thesis are that I) long-term (relative) survival between open versus endovascular aneurysm repair is equal; II) AAA patients remain a persistently high long-term (10-year) excess mortality after elective repair, with no change in mortality rates over the past 25 years; III) women have a notably higher short-and long-term mortality; IV) endovascular and open repair are considered cost equivalent; V) and the evaluation of the patient perspective/quality of life of AAA patients needs improvement. Show less
This thesis has demonstrated the use of mobile health devices for up to three months after cardiothoracic surgery. Mobile health devices, as used in this thesis, were found to increase... Show moreThis thesis has demonstrated the use of mobile health devices for up to three months after cardiothoracic surgery. Mobile health devices, as used in this thesis, were found to increase postoperative atrial fibrillation detection, which may also positively impact complications such as ischemic stroke. Moreover, this thesis demonstrated a positive impact of mobile health on both blood pressure and cholesterol level outcomes, which is hypothesized to be related to an increased patient engagement. Potential pitfalls of mobile health are mHealth literacy in both patients and healthcare providers, data integration and data safety. Future researchers are advised to focus on these factors when implementing or improving mobile health interventions. Show less
Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide. For many years guidelines have listed optimal preventive therapy. More recently, novel therapeutic options have... Show moreCardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide. For many years guidelines have listed optimal preventive therapy. More recently, novel therapeutic options have broadened the options for state-of-the-art CV risk management (CVRM). In the majority of patients with CVD, risk lowering can be achieved by utilising standard preventive medication combined with lifestyle modifications. In a minority of patients, add-on therapies should be considered to further reduce the large residual CV risk. However, the choice of which drug combination to prescribe and in which patients has become increasingly complicated, and is dependent on both the absolute CV risk and the reason for the high risk. In this review, we discuss therapeutic decisions in CVRM, focusing on (1) the absolute CV risk of the patient and (2) the pros and cons of novel treatment options. Show less
The aim of preventive care traditionally refers to measures taken to prevent disease and injury. However, for vulnerable older people the aim to maintain independence and wellbeing seems to be... Show moreThe aim of preventive care traditionally refers to measures taken to prevent disease and injury. However, for vulnerable older people the aim to maintain independence and wellbeing seems to be appropriate. Although a 'gold standard' to stratify for vulnerability in the general older population is lacking, GPs share the same concept of vulnerability for somatic and psychological patient characteristics. However, within the vulnerable older population, there is no evidence (except for physical activity) that a collective screening approach, with a standardized intervention program, will be the most appropriate way to contribute to the maintenance of independence and wellbeing. Moreover, since te majority of vulnerable older people already receive medical care for their chronic disease(s), more benefit can be expected from improving the individual regular care than from a separate screening program. According to GPs, te main topic in the prevention of disease in the general older population is (apart from national programs) cardiovascular risk management. A collective approach, consisting of high risk stratification and treatment, appeared to be possible even at high age. Show less
