Authors' objectives:

On request of the State Secretary of Health, Welfare and Cultural Affairs to inform him about the state of science and its implications for practice, in preparation for a Planning Decree under section 18 of the Hospital Provision Act for tertiary referral centers.

Authors' results and conclusions: Characteristics of pediatric cardiology and heart surgery and their relationship. Congenital heart disease in childhood, adolescence and adulthood. Estimated number of procedures until the year 2000. Requirements for providing quality of care. Clinical:Interventional cardiology for congenital heart disease cannot be regarded as separate from cardiac surgery and the development of interventional cardiology and would be held back without surgery. A child should never undergo surgery if a less invasive alternative is available in the form of a catheter intervention.

Authors' recommendations: Number of procedures (The Netherlands, 15.5 million inhabitants, birthrate 200 000): About 1,000 diagnostic and therapeutic cardiac catheterisations in children annually in the following five years. The contribution of therapeutic catheterisations - currently around 150 - will gradually rise to 250 as a result of developments in the field. The number of diagnostic catheterisations will fall slightly in view of the greater potential for using non-invasive diagnostic imaging techniques. The Committee expects the number of heart operations in children with congenital heart defects to level out at approximately 950 a year, which is the current figure. Requirements:Patients with congenital heart disease should be treated at centers where interventional cardiology and cardiac surgery are fully-fledged specialists and there is extensive formalized cooperation between specialists in both fields. A pediatric cardiac center should have at least four pediatric cardiologists (two specialists working in non-invasive diagnostic and treatment and two in interventional cardiology) and two pediatric cardiac surgeons. The annual number of diagnostic catheterisations performed by each pediatric interventional cardiologist should rise to at least 75 and the number of therapeutic catheterisations to between 25 and 40. The number of operations performed by each pediatric cardiac surgeon should increase to at least 100. The care infrastructure should be similar to that in a university children's hospital; continuity of care, expertise and a child-centered approach are essential. The registration of indications, treatments and follow-up should be made obligatory. Implications for practice: Treatment of children with congenital heart defects must be concentrated in three of the seven centers which exist at present. Other output or dissemination activity: Update report: expected in 2000; Acceptance of recommendations: accepted by the Minister of Health, Welfare and Cultural Affairs; the report will be used as a basis for a Planning Decree under section 18 of the Hospital Provision Act for tertiary referral centers. Changes to practice: concentration of facilities will be effectuated (in the long run).

Authors' methods: Review

Project Status: Completed

URL for project: http://www.gr.nl/

Year Published: 1993

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Netherlands

Organisation Name: Health Council of the Netherlands Gezondheidsraad

Contact Address: Postbus 16052, 2500 BB Den Haag, The Netherlands. Tel: +31 70 340 7520;Fax: +31 70 340 7523

Contact Name: info@gr.nl

Contact Email: info@gr.nl

Copyright: Health Council of the Netherlands Gezondheidsraad