Ralf E. Harskamp
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View article: Patient experiences with a smartwatch 1L-ECG versus traditional Holter monitoring for ambulatory cardiac rhythm monitoring: a qualitative study
Patient experiences with a smartwatch 1L-ECG versus traditional Holter monitoring for ambulatory cardiac rhythm monitoring: a qualitative study Open
Objective To explore patients’ experiences and perspectives on using a direct-to-consumer smartwatch with single-lead electrocardiography (1L-ECG) for ambulatory rhythm diagnostics in primary care. Design Qualitative study using semi-struc…
View article: Left Ventricular Ejection Fraction Assessed by a General Practitioner Using AI-Guided Point-of-Care Ultrasonography: Feasibility and Diagnostic Agreement With Conventional Echocardiography
Left Ventricular Ejection Fraction Assessed by a General Practitioner Using AI-Guided Point-of-Care Ultrasonography: Feasibility and Diagnostic Agreement With Conventional Echocardiography Open
Objective: The aim of this study was to assess whether a general practitioner (GP), without cardiac point-of-care ultrasonography (POCUS) experience, could feasibly and accurately estimate left ventricular ejection fraction (LVEF), using A…
View article: Impact of abnormal ambulatory ECG findings when screening for atrial fibrillation in primary care: a qualitative study among participants of the PATCH-AF trial
Impact of abnormal ambulatory ECG findings when screening for atrial fibrillation in primary care: a qualitative study among participants of the PATCH-AF trial Open
Background and aim European cardiovascular guidelines recommend systematic atrial fibrillation (AF) screening in community-dwelling high-risk patients. However, little is known about the impact of abnormal screening findings, including AF …
View article: Adequately identifying low-risk chest pain in emergency primary care: evaluating the performance of preHEAR(T) based on two European cohorts
Adequately identifying low-risk chest pain in emergency primary care: evaluating the performance of preHEAR(T) based on two European cohorts Open
Background Differentiating cardiac from non-cardiac acute chest pain poses a diagnostic challenge, especially in primary care. The History, ECG, Age, Risk factors and Troponin level (HEART) score aid in risk stratification in hospitals, wh…
View article: Ultrasonography in General Practice: insights from an implementation study in a Low-income neighborhood of Amsterdam
Ultrasonography in General Practice: insights from an implementation study in a Low-income neighborhood of Amsterdam Open
Background Ultrasonography is increasingly being used in primary care settings, facilitated by technological advancements, reduced device-related costs, and improved access to training and support. It holds particular promise for underserv…
View article: Emulation of ARISTOTLE and ROCKET AF trials in real-world atrial fibrillation patients results in similar efficacy and safety as original landmark trials: insights from the GARFIELD-AF registry
Emulation of ARISTOTLE and ROCKET AF trials in real-world atrial fibrillation patients results in similar efficacy and safety as original landmark trials: insights from the GARFIELD-AF registry Open
Aims This study aimed to determine the robustness, reproducibility and representativeness of the landmark Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (AF) (ARISTOTLE) and Rivaroxaban Once Daily O…
View article: Sex differences in chest pain presentation, triage assessment, and outcomes in urgent primary care: findings from the TRACE cohort study
Sex differences in chest pain presentation, triage assessment, and outcomes in urgent primary care: findings from the TRACE cohort study Open
Aim: To evaluate sex differences in the triage and assessment of chest pain in Dutch out-of-hours primary care (OOH-PC). Background: Prior research illustrated differences between women and men with confirmed cardiac ischemia. However, inf…
View article: Chest pain in a multi-ethnic population: A community-based study on sex differences in chest pain prevalence and care contacts
Chest pain in a multi-ethnic population: A community-based study on sex differences in chest pain prevalence and care contacts Open
Chest pain is more commonly reported in women than men across most ethnic groups. While men were less likely to have visited a GP than women, women were less likely to have visited a cardiologist. Combined, this suggests delays in care may…
View article: Safety and efficiency of modified HEART scores without troponin or electrocardiography: an analysis based on two European out-of-hours primary care cohorts
Safety and efficiency of modified HEART scores without troponin or electrocardiography: an analysis based on two European out-of-hours primary care cohorts Open
Background Differentiating between acute chest pain of cardiac versus non-cardiac origin poses a diagnostic challenge. Risk stratification tools, such as the HEART (History, ECG, Age, Risk and Troponin) score, have been developed to aid in…
View article: Adding ethnicity to cardiovascular risk prediction: External validation and model updating of SCORE2 using data from the HELIUS population cohort
Adding ethnicity to cardiovascular risk prediction: External validation and model updating of SCORE2 using data from the HELIUS population cohort Open
Adding ethnicity to the SCORE2 risk prediction model in a middle-aged, multi-ethnic Dutch population did not improve overall discrimination but improved risk classification, potentially helping to address CVD disparities through timely tre…
View article: Chest Pain in Primary Care: A Systematic Review of Risk Stratification Tools to Rule Out Acute Coronary Syndrome
Chest Pain in Primary Care: A Systematic Review of Risk Stratification Tools to Rule Out Acute Coronary Syndrome Open
Clinical decision rules without troponin and the use of conventional troponin showed insufficient sensitivity to rule out ACS in primary care and are not recommended as standalone tools. High-sensitivity troponin strategies are promising, …
View article: Impact of patient selection in clinical trials: application of ROCKET AF and ARISTOTLE criteria in GARFIELD-AF
Impact of patient selection in clinical trials: application of ROCKET AF and ARISTOTLE criteria in GARFIELD-AF Open
Background The extent to which differences in results from Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) and Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitami…
View article: Screening and detection of atrial fibrillation in primary care: current practice and future perspectives
Screening and detection of atrial fibrillation in primary care: current practice and future perspectives Open
Atrial fibrillation (AF) is a common arrhythmia associated with an increased risk of stroke, which can be effectively reduced by prophylaxis initiation and integrated care to reduce cardiovascular risk and AF-related complications. Screeni…
View article: Telephone triage of chest pain in out-of-hours primary care: external validation of a symptom-based prediction rule to rule out acute coronary syndromes
Telephone triage of chest pain in out-of-hours primary care: external validation of a symptom-based prediction rule to rule out acute coronary syndromes Open
Introduction Telephone triage is pivotal for evaluating the urgency of patient care, and in the Netherlands, the Netherlands Triage Standard (NTS) demonstrates moderate discrimination for chest pain. To address this, the Safety First Predi…
View article: Quality of heart failure registration in primary care: observations from 1 million electronic health records in the Amsterdam Metropolitan Area
Quality of heart failure registration in primary care: observations from 1 million electronic health records in the Amsterdam Metropolitan Area Open
Objectives Proper coding of heart failure (HF) in electronic health records (EHRs) is an important prerequisite for adequate care and research towards this vulnerable patient population. We set out to evaluate the accuracy of registration …
View article: Performance of ChatGPT as an AI-assisted decision support tool in medicine: a proof-of-concept study for interpreting symptoms and management of common cardiac conditions (AMSTELHEART-2)
Performance of ChatGPT as an AI-assisted decision support tool in medicine: a proof-of-concept study for interpreting symptoms and management of common cardiac conditions (AMSTELHEART-2) Open
Our study suggests that ChatGPT has potential as an AI-assisted decision support tool in medicine, particularly for straightforward, low-complex medical questions, but further research is needed to fully evaluate its potential.
View article: Troponin testing in routine primary care: observations from a dynamic cohort study in the Amsterdam metropolitan area
Troponin testing in routine primary care: observations from a dynamic cohort study in the Amsterdam metropolitan area Open
Objectives Troponin testing is indicated in the diagnostic work-up of acute coronary syndrome (ACS) and incorporated in risk stratification pathways. This study aims to gain insights on the use, outcomes, and diagnostic accuracy of troponi…
View article: Sex and ethnic differences in unrecognized myocardial infarctions: Observations on recognition and preventive therapies from the multiethnic population-based HELIUS cohort
Sex and ethnic differences in unrecognized myocardial infarctions: Observations on recognition and preventive therapies from the multiethnic population-based HELIUS cohort Open
The prevalence of uMIs was higher in men than women, and sex differences in the proportion of uMIs varied somewhat across ethnic groups. People with uMIs did not receive adequate preventative medications, posing a risk for recurrent events.
View article: Evaluation of the introduction of a single-lead ECG device and digital cardiologist consultation platform among general practitioners in the Netherlands
Evaluation of the introduction of a single-lead ECG device and digital cardiologist consultation platform among general practitioners in the Netherlands Open
Aim: To evaluate the use of a single-lead electrocardiography (1L-ECG) device and digital cardiologist consultation platform in diagnosing arrhythmias among general practitioners (GPs). Background: Handheld 1L-ECG offers a user-friendly al…
View article: Diagnostic accuracy of a smartphone application for artificial intelligence-based interpretation of 12-lead ECG in primary care (AMSTELHEART-1)
Diagnostic accuracy of a smartphone application for artificial intelligence-based interpretation of 12-lead ECG in primary care (AMSTELHEART-1) Open
Background The use of 12-lead electrocardiogram (ECG) is common in routine primary care, however it can be difficult for less experienced ECG readers to adequately interpret the ECG. Objective To validate a novel smartphone application as …
View article: Diagnostic properties of natriuretic peptides and opportunities for personalized thresholds for detecting heart failure in primary care
Diagnostic properties of natriuretic peptides and opportunities for personalized thresholds for detecting heart failure in primary care Open
Objectives Heart failure (HF) is a prevalent syndrome with considerable disease burden, healthcare utilization and costs. Timely diagnosis is essential to improve outcomes. This study aimed to compare the diagnostic performance of B-type n…
View article: Should all electrocardiography be ambulatory?
Should all electrocardiography be ambulatory? Open
Due to technological advances, electrocardiographic parameters can now be obtained by the lay public without going to a clinic or hospital.Consumer-based wearable devices that allow detection of atrial fibrillation (AF) and other arrhythmi…
View article: Characteristics of heart failure in the Amsterdam metropolitan area (AMSTERDAM-HF): Data from a dynamic general practice cohort (2011−2021)
Characteristics of heart failure in the Amsterdam metropolitan area (AMSTERDAM-HF): Data from a dynamic general practice cohort (2011−2021) Open
Our study provides insights into incident HF in a contemporary Western European, multi-ethnic, urban population. It highlights notable sex, age, and geographical differences in incidence rates, risk factors, symptoms and prognosis.
View article: General practitioners’ views on cardiovascular prevention for ethnic minorities—a qualitative study in the Netherlands
General practitioners’ views on cardiovascular prevention for ethnic minorities—a qualitative study in the Netherlands Open
Objectives While ethnic minorities in Europe are disproportionally affected by cardiovascular disease (CVD), little is known about how general practitioners (GPs) perceive differences in risk or care needs across ethnic minority groups. Th…