Expectations and perceived barriers to widespread implementation of e­Health in cardiology practice: Results from a national survey in the Netherlands.

INTRODUCTION: Expectations of physicians concerning e­Health and perceived barriers to implementation in clinical practice are scarcely reported in the literature. The purpose of this study was to assess these aspects of cardiovascular e­Health. METHODS: A survey was sent to members of the Netherlands Society of Cardiology. In total, the questionnaire contained 30 questions about five topics: personal use of smartphones, digital communication between respondents and patients, current e­Health implementation in clinical practice, expectations about e­Health and perceived barriers for e­Health implementation. Age, personal use of smartphones and professional environment were noted as baseline characteristics. RESULTS: In total, 255 respondents filled out the questionnaire (response rate 25%); 89.4% of respondents indicated that they considered e­Health to be clinically beneficial, improving patient satisfaction (90.2%), but also that it will increase the workload (83.9%). Age was a negative predictor and personal use of smartphones was a positive predictor of having high expectations. Lack of reimbursement was identified by 66.7% of respondents as a barrier to e­Health implementation, as well as a lack of reliable devices (52.9%) and a lack of data integration with electronic medical records (EMRs) (69.4%). CONCLUSION: Cardiologists are in general positive about the possibilities of e­Health implementation in routine clinical care; however, they identify deficient data integration into the EMR, reimbursement issues and lack of reliable devices as major barriers. Age and personal use of smartphones are predictors of expectations of e­Health, but the professional working environment is not.

One-year clinical follow-up of a registry evaluating a percutaneous revascularisation strategy combining a pre-specified simple selection process with the use of a new thin-strut bare cobalt-chromium stent.

Objectives. To evaluate clinical events in a specifically selected cohort of patients with obstructive coronary artery disease (CAD), using a new generation thin-strut bare cobalt-chromium coronary stent.Methods. Patients with single- or multi-vessel, stable or unstable CAD eligible for percutaneous implantation of at least one bare cobalt-chromium stent were evaluated in a single-centre registry. Prospective pre-specified criteria for bare cobalt-chromium stent implantation in our centre were: any acute ST-elevation myocardial infarction (MI), otherwise 1) de novo coronary lesion, and 2) lesion length <20 mm, and 3) reference vessel diameter >2.6 mm, and 4) no diabetes, unless reference vessel diameter >3.5 mm. Endpoints, retrospectively collected, were death, MI and clinically driven target-lesion revascularisation (TLR) and target-vessel revascularisation (TVR) after 12 months.Results. Between September 2005 and June 2007, 712 patients (48.7% one-vessel, 29.9% two-vessel, 20% three-vessel and 1.4% left main disease; 7.9% diabetics) were treated with 800 bare cobalt-chromium stents, for stable angina (40.9%), unstable angina (20.9%) or acute ST-elevation MI (38.2%). The procedural success rate was 99.3%. Peri-procedural MI rate was 2.2% in the semi-elective group. At 12 months there were 17 deaths (2.4%), of which nine non-cardiac, 20 (2.8%) MI, 19 (2.7%) TLR and 29 (4.1%) TVR. Early and late definite stent thrombosis occurred in four (0.6%) and three (0.4%) patients, respectively.Conclusion. A strategy aimed at minimising drug-eluting stent use and combining a pre-specified simple selection process with the use of a new thin-strut bare cobalt-chromium stent is safe and effective at one-year clinical follow-up. (Neth Heart J 2010;18:486-92.).