Risk stratification and outcome assessment in cardiac surgery and transcatheter interventions

There is a steady increase in the number of patients undergoing cardiac surgery in The Netherlands [1]. As can be appreciated from Figure 1, 16,877 adult surgical cardiac procedures were performed in 2008. In addition, the number of transcatheter procedures, including valve and coronary stent implantation, is also growing rapidly. Given the ageing of the population and the increasing number of patients with congenital heart disease that reaches adulthood, the number of surgical and transcatheter interventions is likely to increase even further [2, 3]. The growing population requiring these cardiovascular interventions will lead to an increase in health care expenditure. This calls for a cost-effective approach of health care, with constant attention for the relation between cost-effectiveness and quality of care. Quality assessment is an inherent component of this approach. In addition, by improving the quality of care (including optimizing treatment selection), fewer adverse outcomes are to be expected, with a subsequent restraint of costs.