Do we need numbers or quality?

[摘要] For several programmes that are currently under development, the Netherlands Society of Cardiology (NVVC) is providing guidelines with respect to numbers of patients that should be treated to guarantee quality. A centre should perform at least 600 percutaneous coronary interventions (PCI) to qualify for a license. It would seem reasonable to limit the number of centres that perform these procedures in order to prevent an excessive capacity. In addition, for the interventionalist it is crucial to do sufficient cases in order to maintain and expand skills. Yet, if the exact number of procedures is to be leading for the maintenance of a license, this could easily result in a more liberal use of a potentially harmful intervention. Especially in the field of PCI we in the Netherlands are proud of the high number of functional measurements (FFR) preceding a PCI procedure, supported by studies such as DEFER and FAME. In order to provide a high quality of care and to become cost-effective it is crucial that PCI centres do not fall back to just eye-balling in order to decide whether a lesion should be treated or not. Deferring from PCI can be an excellent treatment, but requires informing the patient and referring cardiologist more intensively. Also the number of patients referred for bypass surgery will be further reduced despite the beneficial outcome of CABG.

[学科分类] 心脏病和心血管学