QUALITY-CONTROL FOR INVASIVE CARDIOLOGY - HOLLAND

Although no official registration of indications, treatments and resul ts in patients with coronary heart disease has taken place in Holland, the following authorities and commissions have introduced guidelines for quality control: the Dutch government, the Dutch Society of Cardio logy, the Working Group on Interventional Cardiology and the health in surers. Until 1991, the right to perform coronary interventions was ti ed to a license issued by the Ministry of Health. New recommendations were delineated 5 years ago: at least 500 interventions must be annual ly performed by 5 interventional cardiologists, i.e. ca. 100 intervent ions annually per cardiologist. No interventional cardiology may be pe rformed without an in-house cardiac surgery and vice versa. In a surve y by the Dutch Society of Cardiology on the quality of the Dutch cente rs, PTCA-mortality was ca. 0.3%, infarction rate was ca. 2%. An emerge ncy bypass operation was necessary in 1.0 to 1.6% of the cases; the su rgical team was on immediate alert for 11% of the patients. Selection of patients without risk was deemed impossible. Despite objections by some members the Dutch Society of Cardiology, it was recommended that cardiac surgery and interventions should not be separated. Data from h ealth insurers showed no inappropriate indications for PTCA. The DUCAT -study, which used the RAND criteria, showed PTCA indications to be co rrect in more than 90% of the cases. The Dutch government Rants to con trol the expansion of PTCA centers, so it is no wonder that waiting li sts are becoming longer.