{"id":"f081708e0e26","type":"article","url":"https://hartvaat.nl/2026/03/31/gespecialiseerde-hartklepklinieken-leiden-tot-betere-richtlijnconforme-zorg/","title":"Gespecialiseerde hartklepklinieken leiden tot betere richtlijnconforme zorg","title_en":"Specialised heart valve clinics result in greater adherence to guideline-directed care: a comparative study","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["vrouwen"],"journal":"Open Heart","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e003608?rss=1","source_url":"https://doi.org/http://openheart.bmj.com/cgi/content/short/13/1/e003608?rss=1","authors":["Montarello","N.","Page","C.","Bennett","S.","Androshchuk","V.","Saeed","S.","Grigoryan","K.","Demetrescu","C.","Zhou","C.","Rajani","R."],"significance":5,"published":"2026-03-31","source_date":"2026-03-31","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/endocarditis-profylaxe/","https://hartvaat.nl/kennis/vasculair/claudicatio-intermittens/"],"congress":"","summary_en":"International guidelines emphasise the role of heart valve centres and specialist heart valve clinics (SHVC) in optimal care for valve disease. In this comparative study, 134 patients with valve disease seen outside an SHVC were compared with 173 SHVC attendees against international guidelines. Outside the SHVC, the relationship between symptoms and valve disease was more often undocumented (31.5% vs 5.7%), exercise testing was used far less (3.4% vs 32%) and surgical referral was lower (3.4% vs 26.8%); no patient with prior valve surgery received endocarditis-prevention advice outside the SHVC (vs 100% within). Overall, management was discordant in 38% of native-valve and 84% of prior-surgery patients outside the SHVC, versus 3-4% within. Almost 5% of valve patients are thus still seen outside a specialist clinic and receive suboptimal care.","created":"2026-07-03T10:32:20Z","updated":"2026-07-03T13:31:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Internationale richtlijnen benadrukken het belang van hartklepcentra en gespecialiseerde hartklepklinieken (SHVC) voor optimale zorg bij hartklepziekte. In deze vergelijkende studie werden 134 patiënten met klepziekte die niet in een SHVC werden gezien, vergeleken met 173 SHVC-bezoekers, getoetst aan internationale richtlijnen. Buiten de SHVC werd de relatie tussen klachten en de klepziekte vaker niet gedocumenteerd (31,5% vs. 5,7%), werd inspanningstesten veel minder gebruikt (3,4% vs. 32%) en werd minder vaak naar chirurgie verwezen (3,4% vs. 26,8%); geen enkele patiënt met eerdere klepchirurgie kreeg buiten de SHVC endocarditisprofylaxe-advies (vs. 100% binnen). In totaal was de behandeling discordant bij 38% van de patiënten met natieve klepziekte en 84% met eerdere chirurgie buiten de SHVC, tegen 3-4% binnen de SHVC. Bijna 5% van de kleppatiënten wordt dus nog buiten een gespecialiseerde kliniek gezien en krijgt suboptimale zorg.","abstract_original":"<sec><st>Introduction</st>\n<p>International guidelines emphasise the role of heart valve centres (HVC) and specialist heart valve clinics (SHVC) to deliver optimal care to patients with heart valve disease (HVD). We sought to determine whether we could reaffirm the importance of SHVCs in our centre.</p>\n</sec>\n<sec><st>Methods</st>\n<p>A total of 3731 consecutive non-SHVC (N-SHVC) patients were reviewed over 18 months. Patients (134) with a primary diagnosis of HVD were compared with 173 consecutive SHVC attendees based on international guidelines. Concordance was defined as adherence to recommended frequency of follow-up, investigations, timing of surgery and valve care advice, and discordance as any deviation from this.</p>\n</sec>\n<sec><st>Results</st>\n<p>Of 134 N-SHVC patients (4.5%) with HVD, 89 (66.4%) had native valve disease and 45 (33.6%) prior heart valve surgery compared with 123 (71.1%) and 50 (28.9%) of SHVC patients, respectively, in the SHVC cohort. In symptomatic patients, the relationship to HVD was not documented in 31.5% of N-SHVC patients versus 5.7% of SHVC patients (p&lt;0.001). Exercise testing was used infrequently in N-SHVCs compared with SHVCs (3.4% vs 32%, p&lt;0.001) and surgical referral was lower (3.4% vs 26.8%, p&lt;0.001). No N-SHVC patients with prior valve surgery received endocarditis prevention advice compared with 100% of SHVC patients. Overall, 34 (38.2%) of N-SHVC patients with native valve disease and 34 (84.4%) with prior cardiac surgery had discordant management compared with 4 (3.3%) and 2 (4%) of SHVC patients respectively.</p>\n</sec>\n<sec><st>Conclusion</st>\n<p>Almost 5% of patients with valve disease are still seen in an N-SHVC setting despite the availability of an SHVC within the same institute and receive suboptimal care.</p>\n</sec>"}