The impact and challenges of implementing CTCA according to the 2019 ESC guidelines on chronic coronary syndromes: a survey and projection of CTCA services in the Netherlands

Insights into Imaging

H. J. Siebelink¹  S. C. A. M. Bekkers²  P. Damman³  M. Voskuil⁴  R. N. Planken⁵  J. Stoker⁶  H. J. Lamb⁷  M. Prokop⁸  W. van Es⁹  R. Vliegenthart^1,10  T. Leiner^1,11  J. R. Timmer^1,12  H. C. Willems^1,13  J. P. Henriques^1,14  S. M. Boekholdt^1,14  B. E. P. M. Claessen^1,15  T. P. W. van den Boogert^1,16  S. F. Schuiling^1,17 

[1] Department of Cardiology, Leiden University Medical centre, Leiden, The Netherlands;Department of Cardiology, Maastricht University Medical centre, Maastricht, The Netherlands;Department of Cardiology, Radboud University Medical centre, Nijmegen, The Netherlands;Department of Cardiology, Utrecht University Medical centre, Utrecht, The Netherlands;Department of Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands;Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands;Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands;Department of Radiology and Nuclear Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands;Department of Radiology, Leiden University Medical centre, Leiden, The Netherlands;Department of Radiology, Nuclear Medicine, and Anatomy, Radboud University Medical centre, Nijmegen, The Netherlands;Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands;Department of Radiology, University Medical centre Groningen, Groningen, The Netherlands;Department of Radiology, Utrecht University Medical centre, Utrecht, The Netherlands;Departments of Cardiology, Isala, Zwolle, The Netherlands;Division of Geriatrics, Department of Internal Medicine, Amsterdam UMC, Amsterdam, The Netherlands;Heart centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands;Heart centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands;Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands;Heart centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands;Department of Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands;Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands;Zorgevaluatie en Gepast Gebruik, Diemen, The Netherlands;

关键词: Computed Tomography Angiography;    Coronary artery disease;    Guidelines;   

DOI  :  10.1186/s13244-021-01122-2

来源: Springer

【 摘 要 】

BackgroundThe 2019 ESC-guidelines on chronic coronary syndromes (ESC-CCS) recommend computed tomographic coronary angiography (CTCA) or non-invasive functional imaging instead of exercise ECG as initial test to diagnose obstructive coronary artery disease. Since impact and challenges of these guidelines are unknown, we studied the current utilisation of CTCA-services, status of CTCA-protocols and modeled the expected impact of these guidelines in the Netherlands.Methods and resultsA survey on current practice and CTCA utilisation was disseminated to every Dutch hospital organisation providing outpatient cardiology care and modeled the required CTCA capacity for implementation of the ESC guideline, based on these national figures and expert consensus. Survey response rate was 100% (68/68 hospital organisations). In 2019, 63 hospital organisations provided CTCA-services (93%), CTCA was performed on 99 CTCA-capable CT-scanners, and 37,283 CTCA-examinations were performed. Between the hospital organisations, we found substantial variation considering CTCA indications, CTCA equipment and acquisition and reporting standards. To fully implement the new ESC guideline, our model suggests that 70,000 additional CTCA-examinations would have to be performed in the Netherlands.ConclusionsDespite high national CTCA-services coverage in the Netherlands, a substantial increase in CTCA capacity is expected to be able to implement the 2019 ESC-CCS recommendations on the use of CTCA. Furthermore, the results of this survey highlight the importance to address variations in image acquisition and to standardise the interpretation and reporting of CTCA, as well as to establish interdisciplinary collaboration and organisational alignment.

【 授权许可】

CC BY