Risk stratification, the systematic assessment of patients’ profiles in order to assign individual risk scores, can be used to provide personalized and population care according to that risk. In... Show moreRisk stratification, the systematic assessment of patients’ profiles in order to assign individual risk scores, can be used to provide personalized and population care according to that risk. In different countries, risk stratification is used to identify the right subpopulations for specific care interventions and lower expensive care utilization such as emergency care and hospitalization. In the Netherlands, risk stratification is not yet notably used in primary care. Despite the great possibilities due to the widespread catchment area of primary care in the Netherlands and the gatekeepers function of general practitioners, systematic risk stratification approaches in Dutch primary care are minimal. The aim of this dissertation was therefor to identify and asses a suitable risk stratification tool to be used in Dutch primary care. The main question was answered by describing a study assessing the model performance of US-based hospitalization and high costs models applied in the Dutch primary care setting. Both models showed good performance regarding discrimination and calibration properties. In addition, the models were adjusted to best fit the Dutch primary care situation. Coefficients of the underlying predictors of the models were adjusted, improving the good model performances for both the hospitalization and the high costs model. Show less
This thesis aimed to evaluate and improve the risk stratification of outpatient management in acute pulmonary embolism (PE) patients. In addition, this thesis aimed to establish current patterns of... Show moreThis thesis aimed to evaluate and improve the risk stratification of outpatient management in acute pulmonary embolism (PE) patients. In addition, this thesis aimed to establish current patterns of home treatment and to assess the safety of anticoagulant treatment in PE patients. Finally, this thesis aimed to provide an overview of outpatient treatment of venous thromboembolism (VTE) in cancer patients at high risk of adverse events. Show less
The general introduction of this thesis gives an overview of the epidemiology of ST-segment elevation myocardial infarction (STEMI) and the current focus of the guidelines concerning the management... Show moreThe general introduction of this thesis gives an overview of the epidemiology of ST-segment elevation myocardial infarction (STEMI) and the current focus of the guidelines concerning the management of these patients. In the past decades changes in the treatment and outcome of STEMI patients have influenced the risk stratification of this population and the focus has been shifted to the evaluation of infarct size. Furthermore, the role of echocardiography in the risk stratification after STEMI is addressed including the evolving echocardiographic techniques. The aim of the current thesis was to evaluate the clinical characteristics of this contemporary population of STEMI patients and to assess the value of echocardiography for the improvement of the risk stratification of these patients. First, the current population of STEMI patients treated with primary percutaneous coronary intervention is described in Part I, where clinical parameters are being evaluated in relation to short- and long-term outcome. In Part II, the role of conventional and novel echocardiographic techniques is being evaluated for the assessment of left ventricular (LV) systolic function and the importance of LV diastolic function is addressed in Part III. Finally, the role of echocardiography in patients with chronic ischemic heart disease is studied in Part IV. Show less
Non-invasive imaging plays an increasingly important role in the diagnosis and risk stratification of coronary artery disease. Several techniques such as stress echocardiography and myocardial... Show moreNon-invasive imaging plays an increasingly important role in the diagnosis and risk stratification of coronary artery disease. Several techniques such as stress echocardiography and myocardial perfusion imaging have become available to assess cardiac function and myocardial perfusion. With the arrival of multi-slice computed tomography coronary angiography (CTA), non-invasive imaging of coronary anatomy has also become possible. CTA is a relatively new imaging technique; the objective of the thesis is therefore to explore the value of CTA for diagnosis and risk stratification of CAD in patients presenting with suspected and known CAD, in order to further define its role in clinical practice. The results of this thesis show that CTA provides important diagnostic information relative to existing non-invasive imaging strategies. In addition the detailed anatomic information obtained using CTA was shown to provide important prognostic information. CTA supplies complementary information to existing non-invasive imaging techniques, and has the potential to provide a more patient tailored approach to patient management. What remains to be determined is how CTA and non-invasive functional imaging should be integrated into clinical practice. Show less
