1
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Man JP, Koole MAC, Meregalli PG, Handoko ML, Stienen S, de Lange FJ, Winter MM, Schijven MP, Kok WEM, Kuipers DI, van der Harst P, Asselbergs FW, Zwinderman AH, Dijkgraaf MGW, Chamuleau SAJ, Schuuring MJ. Digital consults in heart failure care: a randomized controlled trial. Nat Med 2024:10.1038/s41591-024-03238-6. [PMID: 39217271 DOI: 10.1038/s41591-024-03238-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 08/07/2024] [Indexed: 09/04/2024]
Abstract
Guideline-directed medical therapy (GDMT) has clear benefits on morbidity and mortality in patients with heart failure; however, GDMT use remains low. In the multicenter, open-label, investigator-initiated ADMINISTER trial, patients (n = 150) diagnosed with heart failure and reduced ejection fraction (HFrEF) were randomized (1:1) to receive usual care or a strategy using digital consults (DCs). DCs contained (1) digital data sharing from patient to clinician (pharmacotherapy use, home-measured vital signs and Kansas City Cardiomyopathy Questionnaires); (2) patient education via a text-based e-learning; and (3) guideline recommendations to all treating clinicians. All remotely gathered information was processed into a digital summary that was available to clinicians in the electronic health record before every consult. All patient interactions were standardly conducted remotely. The primary endpoint was change in GDMT score over 12 weeks (ΔGDMT); this GDMT score directly incorporated all non-conditional class 1 indications for HFrEF therapy with equal weights. The ADMINISTER trial met its primary outcome of achieving a higher GDMT in the DC group after a follow-up of 12 weeks (ΔGDMT score in the DC group: median 1.19, interquartile range (0.25, 2.3) arbitrary units versus 0.08 (0.00, 1.00) in usual care; P < 0.001). To our knowledge, this is the first multicenter randomized controlled trial that proves a DC strategy is effective to achieve GDMT optimization. ClinicalTrials.gov registration: NCT05413447 .
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Affiliation(s)
- Jelle P Man
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
- Amsterdam Cardiovascular Science, University of Amsterdam, Amsterdam, The Netherlands
| | - Maarten A C Koole
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
- Cardiology Center of the Netherlands, Utrecht, The Netherlands
- Department of Cardiology, Red Cross Hospital, Beverwijk, The Netherlands
| | - Paola G Meregalli
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Science, University of Amsterdam, Amsterdam, The Netherlands
| | - M Louis Handoko
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Science, University of Amsterdam, Amsterdam, The Netherlands
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Susan Stienen
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Science, University of Amsterdam, Amsterdam, The Netherlands
| | - Frederik J de Lange
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Science, University of Amsterdam, Amsterdam, The Netherlands
| | - Michiel M Winter
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Science, University of Amsterdam, Amsterdam, The Netherlands
- Cardiology Center of the Netherlands, Utrecht, The Netherlands
| | | | - Wouter E M Kok
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Science, University of Amsterdam, Amsterdam, The Netherlands
| | - Dorianne I Kuipers
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Science, University of Amsterdam, Amsterdam, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
- Institute of Health Informatics, University College London, London, UK
- National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, University College London, London, UK
| | - Aeilko H Zwinderman
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, The Netherlands
- Methodology, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, The Netherlands
- Methodology, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Steven A J Chamuleau
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
- Amsterdam Cardiovascular Science, University of Amsterdam, Amsterdam, The Netherlands
| | - Mark J Schuuring
- Department of Cardiology, Medical Spectrum Twente, Enschede, The Netherlands.
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands.
- Cardiovascular Health Research Pillar, University of Twente, Enschede, The Netherlands.
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2
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Matsumoto S, Henderson AD, Shen L, Yang M, Swedberg K, Vaduganathan M, van Veldhuisen DJ, Solomon SD, Pitt B, Zannad F, Jhund PS, McMurray JJV. Mineralocorticoid Receptor Antagonists in Patients With Heart Failure and Impaired Renal Function. J Am Coll Cardiol 2024; 83:2426-2436. [PMID: 38739064 DOI: 10.1016/j.jacc.2024.03.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Kidney dysfunction often leads to reluctance to start or continue life-saving heart failure (HF) therapy. OBJECTIVES This study sought to examine the efficacy and safety of mineralocorticoid receptor antagonists (MRAs) in patients with HF with reduced ejection fraction experiencing significant kidney dysfunction. METHODS We pooled individual patient data from the RALES (Randomized Aldactone Evaluation Study) and EMPHASIS-HF (Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure) trials. The association between MRA treatment and outcomes was assessed according to whether the estimated glomerular filtration rate (eGFR) declined to <30 mL/min/1.73 m2 or not. The primary outcome was cardiovascular death or HF hospitalization. RESULTS Among 4,355 patients included, 295 (6.8%) experienced a deterioration of eGFR after randomization to <30 mL/min/1.73 m2. These patients had more impaired baseline cardiac and kidney function (eGFR 47.3 ± 13.4 mL/min/1.73 m2 vs 70.5 ± 21.8 mL/min/1.73 m2) and had a higher risk of the primary outcome than patients without eGFR deterioration (HR: 2.49; 95% CI: 2.01-3.08; P < 0.001). However, the risk reduction in the primary outcome with MRA therapy was similar in those who experienced a decrease in eGFR to <30 mL/min/1.73 m2 (HR: 0.65; 95% CI: 0.43-0.99) compared with those who did not (HR: 0.63; 95% CI: 0.56-0.71) (Pinteraction = 0.87). In patients with a decrease in eGFR to <30 mL/min/1.73 m2, 21 fewer individuals (per 100 person-years) experienced the primary outcome with MRA treatment, vs placebo, compared with an excess of 3 more patients with severe hyperkalemia (>6.0 mmol/L). CONCLUSIONS Because patients experiencing a decrease in eGFR to <30 mL/min/1.73 m2 are at very high risk, the absolute risk reduction with an MRA in these patients is large and this decline in eGFR should not automatically lead to treatment discontinuation.
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Affiliation(s)
- Shingo Matsumoto
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Alasdair D Henderson
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Li Shen
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Mingming Yang
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Karl Swedberg
- Department of Emergency and Cardiovascular Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dirk J van Veldhuisen
- Department of Cardiology, Thorax Center, University Medical Center Groningen, Groningen, the Netherlands
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bertram Pitt
- Department of Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Faiez Zannad
- Centre d'Investigations Cliniques Plurithématique 1433, French Institute of Health and Medical Research U1116, French Clinical Research Infrastructure Network-Investigation Network Initiative-Cardiovascular and Renal Clinical Trials, Centre Hospitalier Régional Universitaire de Nancy, Université de Lorraine, Nancy, France
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
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Kresoja K, Adamo M, Rommel K, Stolz L, Karam N, Giannini C, Melica B, von Bardeleben RS, Butter C, Horn P, Praz F, Kalbacher D, Iliadis C, Thiele H, Hausleiter J, Metra M, Lurz P. Guideline-directed medical therapy assessment in heart failure patients undergoing percutaneous mitral valve repair. ESC Heart Fail 2024; 11:1802-1807. [PMID: 38351672 PMCID: PMC11098622 DOI: 10.1002/ehf2.14705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/27/2023] [Accepted: 01/13/2024] [Indexed: 05/18/2024] Open
Abstract
AIMS Achieving optimized guideline-directed medical therapy (GDMT) is recommended prior to transcatheter mitral valve edge-to-edge repair (M-TEER) for secondary mitral regurgitation (SMR). We aimed to propose and validate an easy-to-use score for assessing the quality of GDMT in patients with heart failure with reduced ejection fraction (HFrEF) undergoing M-TEER. METHODS AND RESULTS Among the 1641 EuroSMR patients enrolled in the EuroSMR Registry who underwent M-TEER, a total of 1072 patients [median age 74, interquartile range (IQR) 67-79 years, 29% female] had complete data on GDMT and a left ventricular ejection fraction ≤ 40% and were included in the current study. We proposed a GDMT score that considers the dosage levels of three medication classes (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors, beta-blockers, and mineralocorticoid receptor antagonists), with a maximum score of 12 points indicating optimal GDMT. The primary outcome was all-cause mortality. The median GDMT score was 4 points (IQR 3-6). All three domains of the scoring system were associated with all-cause mortality (P < 0.05 for all). The overall GDMT score was associated with all-cause mortality (hazard ratio 0.90, 95% confidence interval 0.86-0.95 for each 1-point increase in the GDMT score). This association remained significant after adjusting for renal function and co-morbidities. CONCLUSIONS This study demonstrates the utility of a simple GDMT scoring system for assessing the adequacy of GDMT in HFrEF patients with relevant SMR undergoing M-TEER. The GDMT score has potential applications in guiding the design of future clinical trials and aiding clinical decision-making processes.
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Affiliation(s)
- Karl‐Patrik Kresoja
- Department of CardiologyUniversity Medical Center of MainzMainzGermany
- Department of Internal Medicine/CardiologyHeart Center Leipzig at University of Leipzig and Leipzig Heart ScienceStrümpellstraße 39Leipzig04289Germany
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Karl‐Phillipp Rommel
- Department of CardiologyUniversity Medical Center of MainzMainzGermany
- Department of Internal Medicine/CardiologyHeart Center Leipzig at University of Leipzig and Leipzig Heart ScienceStrümpellstraße 39Leipzig04289Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik IKlinikum der Universität MünchenMunichGermany
| | - Nicole Karam
- Department of CardiologyEuropean Hospital Georges Pompidou and Paris Cardiovascular Research Center, INSERM U970ParisFrance
| | - Cristina Giannini
- Cardiothoracic and Vascular DepartmentAzienda Ospedaliero‐Universitaria PisanaPisaItaly
| | - Bruno Melica
- Centro Hospitalar Vila Nova de GaiaEspinhoPortugal
| | | | - Christian Butter
- Department of Cardiology, Immanuel Heart Center BernauBrandenburg Medical School Theodor FontaneBernauGermany
| | - Patrick Horn
- Department of Cardiology, Heart CenterUniversity Hospital of DüsseldorfDüsseldorfGermany
| | - Fabien Praz
- Universitätsklinik für Kardiologie, Inselspital BernBernSwitzerland
| | - Daniel Kalbacher
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/LübeckHamburgGermany
| | - Christos Iliadis
- Department of Cardiology, Heart CenterUniversity Hospital of CologneCologneGermany
| | - Holger Thiele
- Department of CardiologyUniversity Medical Center of MainzMainzGermany
- Department of Internal Medicine/CardiologyHeart Center Leipzig at University of Leipzig and Leipzig Heart ScienceStrümpellstraße 39Leipzig04289Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik IKlinikum der Universität MünchenMunichGermany
| | - Marco Metra
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Philipp Lurz
- Department of CardiologyUniversity Medical Center of MainzMainzGermany
- Department of Internal Medicine/CardiologyHeart Center Leipzig at University of Leipzig and Leipzig Heart ScienceStrümpellstraße 39Leipzig04289Germany
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Beghini A, Sammartino AM, Papp Z, von Haehling S, Biegus J, Ponikowski P, Adamo M, Falco L, Lombardi CM, Pagnesi M, Savarese G, Metra M, Tomasoni D. 2024 update in heart failure. ESC Heart Fail 2024. [PMID: 38806171 DOI: 10.1002/ehf2.14857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/30/2024] Open
Abstract
In the last years, major progress has occurred in heart failure (HF) management. The 2023 ESC focused update of the 2021 HF guidelines introduced new key recommendations based on the results of the last years of science. First, two drugs, sodium-glucose co-transporter-2 (SGLT2) inhibitors and finerenone, a novel nonsteroidal, selective mineralocorticoid receptor antagonist (MRA), are recommended for the prevention of HF in patients with diabetic chronic kidney disease (CKD). Second, SGLT2 inhibitors are now recommended for the treatment of HF across the entire left ventricular ejection fraction spectrum. The benefits of quadruple therapy in patients with HF with reduced ejection fraction (HFrEF) are well established. Its rapid and early up-titration along with a close follow-up with frequent clinical and laboratory re-assessment after an episode of acute HF (the so-called 'high-intensity care' strategy) was associated with better outcomes in the STRONG-HF trial. Patients experiencing an episode of worsening HF might require a fifth drug, vericiguat. In the STEP-HFpEF-DM and STEP-HFpEF trials, semaglutide 2.4 mg once weekly administered for 1 year decreased body weight and significantly improved quality of life and the 6 min walk distance in obese patients with HF with preserved ejection fraction (HFpEF) with or without a history of diabetes. Further data on safety and efficacy, including also hard endpoints, are needed to support the addition of acetazolamide or hydrochlorothiazide to a standard diuretic regimen in patients hospitalized due to acute HF. In the meantime, PUSH-AHF supported the use of natriuresis-guided diuretic therapy. Further options and most recent evidence for the treatment of HF, including specific drugs for cardiomyopathies (i.e., mavacamten in hypertrophic cardiomyopathy and tafamidis in transthyretin cardiac amyloidosis), device therapies, cardiac contractility modulation and percutaneous treatment of valvulopathies, with the recent finding from the TRILUMINATE Pivotal trial, are also reviewed in this article.
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Affiliation(s)
- Alberto Beghini
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Antonio Maria Sammartino
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Zoltán Papp
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Jan Biegus
- Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland
| | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Luigi Falco
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, Naples, Italy
| | - Carlo Mario Lombardi
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Gianluigi Savarese
- Cardiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Daniela Tomasoni
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Cardiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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5
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Man JP, Dijkgraaf MG, Handoko ML, de Lange FJ, Winter MM, Schijven MP, Stienen S, Meregalli P, Kok WE, Kuipers DI, van der Harst P, Koole MA, Chamuleau SA, Schuuring MJ. Digital consults to optimize guideline-directed therapy: design of a pragmatic multicenter randomized controlled trial. ESC Heart Fail 2024; 11:560-569. [PMID: 38146630 PMCID: PMC10804150 DOI: 10.1002/ehf2.14634] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/16/2023] [Accepted: 11/26/2023] [Indexed: 12/27/2023] Open
Abstract
AIMS Many heart failure (HF) patients do not receive optimal guideline-directed medical therapy (GDMT) despite clear benefit on morbidity and mortality outcomes. Digital consults (DCs) have the potential to improve efficiency on GDMT optimization to serve the growing HF population. The investigator-initiated ADMINISTER trial was designed as a pragmatic multicenter randomized controlled open-label trial to evaluate efficacy and safety of DC in patients on HF treatment. METHODS AND RESULTS Patients (n = 150) diagnosed with HF with a reduced ejection fraction will be randomized to DC or standard care (1:1). The intervention group receives multifaceted DCs including (i) digital data sharing (e.g. exchange of pharmacotherapy use and home-measured vital signs), (ii) patient education via an e-learning, and (iii) digital guideline recommendations to treating clinicians. The consults are performed remotely unless there is an indication to perform the consult physically. The primary outcome is the GDMT prescription rate score, and secondary outcomes include time till full GDMT optimization, patient and clinician satisfaction, time spent on healthcare, and Kansas City Cardiomyopathy Questionnaire. Results will be reported in accordance to the CONSORT statement. CONCLUSIONS The ADMINISTER trial will offer the first randomized controlled data on GDMT prescription rates, time till full GDMT optimization, time spent on healthcare, quality of life, and patient and clinician satisfaction of the multifaceted patient- and clinician-targeted DC for GDMT optimization.
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Affiliation(s)
- Jelle P. Man
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Department of CardiologyAmsterdam UMC location VUmcAmsterdamThe Netherlands
- Netherlands Heart InstituteUtrechtThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Marcel G.W. Dijkgraaf
- Department of Epidemiology and Data ScienceAmsterdam UMCAmsterdamThe Netherlands
- Department of MethodologyAmsterdam Public HealthAmsterdamThe Netherlands
| | - M. Louis Handoko
- Department of CardiologyAmsterdam UMC location VUmcAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Frederik J. de Lange
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Michiel M. Winter
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
- Cardiology Center of the NetherlandsAmsterdamThe Netherlands
| | | | - Susan Stienen
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Paola Meregalli
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Wouter E.M. Kok
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Dorianne I. Kuipers
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Pim van der Harst
- Department of CardiologyUniversity Medical Center UtrechtHeidelberglaan 1003584 CXUtrechtThe Netherlands
| | - Maarten A.C. Koole
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Cardiology Center of the NetherlandsAmsterdamThe Netherlands
- Department of CardiologyRed Cross HospitalBeverwijkThe Netherlands
| | - Steven A.J. Chamuleau
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Department of CardiologyAmsterdam UMC location VUmcAmsterdamThe Netherlands
- Netherlands Heart InstituteUtrechtThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Mark J. Schuuring
- Department of CardiologyAmsterdam UMC location VUmcAmsterdamThe Netherlands
- Netherlands Heart InstituteUtrechtThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
- Department of CardiologyUniversity Medical Center UtrechtHeidelberglaan 1003584 CXUtrechtThe Netherlands
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