In the Netherlands, about 10.000 patients a year have cardiac symptoms like angina or dyspnea due to dysfunction of the smallest blood vessels of the heart, so called microvascular coronary dysfunction (MCD). Unfortunately , this ischemic heart condition is often missed because the standard cardiology tests such as a coronary angiogram cannot visualize the smallest vessels of the heart. Many of these patients suffer severe, persistent symptoms leading to substantial healthcare utilization including unnecessary repeat coronary angiograms and frequent first aid visits, with high associated costs, a diminished quality of life, and even an unfavorable cardiovascular prognosis.
Aim and relevance of the initiative
In November 2015, we started a specialized outpatient clinic for patients with suspected MCD, based on the Value-Based Health Care principle. Our aim is to provide better healthcare at lower cost by applying accurate diagnostic tests and proper treatment strategies. Standardized patient driven outcome measures are related to health care provision and related costs to cyclic evaluate our quality of care in relation to its costs.
The standardized data are also an important source for clinical research on MCD, which will boost our clinical care.
Our second aim and to educate other physicians and the general population about MCD so that this under-diagnosed disease, occurring in an important number of patients, will be better recognized in the future.
Outpatient Cardiology Clinic Radboudumc Nijmegen, The Netherlands
Although MCD also occurs in men, this disease predominantly occurs in middle aged women with multiple cardiovascular risk factors without significant stenoses in their large coronary arteries. Symptoms include angina, shortness of breath and/or fatigue, and are often that severe that quality of life is diminished.
Patients are periodically seen by a specialized cardiologist, who is responsible for the diagnosis and medical treatment and by a specialized nurse who, together with the patient, makes an individualized treatment plan, based on the patient’s healthcare needs. This can include a.o. physiotherapy, occupational therapy, treatment by a medical psychologist or psychiatrist, a stress reduction programme (mindfulness). Twice a year patients and provider reported outcome measures are obtained, partly by standardized questionnaires, together with costs to evaluate and improve patient value.
Size and scope
It is estimated that in the Netherlands, 10.000 new patients a year suffer from MCD. For starters, we aim to help 400 new patients a year in our dedicated outpatient clinic. By educating other healthcare professionals, our goal is that MCD is better recognized and subsequently adequately treated in the entire country.