BENEFIT

Heart failure poses a large burden on patients and healthcare, largely because heart failure patients have low fitness and require frequent hospitalisation for close monitoring. In CardiacCare@Home, researchers work together with patients, doctors, industry, and others to develop technology for home-based monitoring of cardiac function and rehabilitation. This approach facilitates early detection of worsening of cardiac function, which allows doctors to rapidly alter treatment and prevent hospitalisation. Moreover, home-based rehabilitation will improve patients’ fitness levels. Technological innovations will facilitate a new care path that improves patients’ quality of life and lower socio-economic costs, and lower burden for hospital staff. The research CardiacCare@Home has the following aims: To integrate a feasible, easy-to-use monitoring + biomarker system within the home environment of patients with HF, that is validated against gold standard measures, and to identify parameters suitable for integrated, frequent patient evaluation to improve and personalise treatment. To design an inclusive transmural home-based cardiac rehabilitation programme, personalised to patient (and caregivers) and disease characteristics, tailored to the needs and preferences and co-created with relevant end-users using a combination of user-friendly sensors and an eHealth platform. To develop a data analytics and decision support system to be incorporated in a novel eHealth platform to (i) enable effective monitoring of vital signs for the personalised, early detection of clinical deterioration, and (ii) facilitate personalised behaviour change to improve participation in rehabilitation. Co-develop an integrated, AI-driven, home-based monitoring and/or home-based rehabilitation program in patients with chronic HF after hospital admission due to decompensated HF, and assess its effects on quality of life, functional capacity and re-hospitalisation (WP3). To assess the impact, including cost-effectiveness and budget impact, of the home-based monitoring and/or rehabilitation CardiacCare@Home-intervention compared to current care from the perspective of patients with HF, healthcare providers, health insurance companies, and society. The origin Heart failure is linked to poor hospital recovery, low functional capacity, and high risk of hospital re-admission. CardiacCare@Home aims to develop and adopt innovative technology for home-based monitoring and cardiac telerehabilitation to improve quality of life, reduce admission and lower healthcare costs. This project was funded by the NWO perspective TTW. This public-private program stimulates the development of innovative technologies that may impact economy and society.

The SARS-CoV-2 pandemic has a high burden of morbidity and mortality due to development of the acute respiratory distress syndrome (ARDS). The reninangiotensin-system (RAS) plays an important role in the development of ARDS, with ACE2 (angiotensin-converting enzyme 2) being a key enzyme within this. The virus's spike protein binds to ACE2, facillitating cellular internalization. Downregulation of ACE2 results in the excessive accumulation of angiotensin II, which in turn increases pulmonary vascular permeability through stimulation of the angiotensin II type 1a receptor (AT1R), thereby exacerbating lung pathology associated with decreased ACE2 activity. Currently available AT1R blockers (ARBs) such as valsartan, have shown potential to block this pathological process mediated by angiotensin II. The Focus The primary aim of the PRAETORIAN-COVID trial is to investigate the effect of the ARB valsartan compared to placebo on the composite end point of admission to an intensive care unit, mechanical ventilation, or death of COVID-19 patients. The Research Participants receiving active treatment are administered valsartan at a dosage titrated to blood pressure, with a maximum of 160 mg twice daily. Participants receiving placebo are provided with a matching placebo. The treatment duration was 14 days or until reaching the primary endpoint, or until hospital discharge, if applicable within 14 days.Two complementary mechanisms underpin the potential efficacy of angiotensin II type 1 receptor blockers (ARBs) in preventing acute respiratory distress syndrome (ARDS) and reducing morbidity and mortality: ARBs block excessive angiotensin-mediated activation of the AT1R. ARBs upregulate ACE2 expression, leading to reduced angiotensin II levels and increased production of the protective vasodilator angiotensin 1–7. Given these mechanisms, ARBs show promise in preventing ARDS development, potentially reducing the need for intensive care unit (ICU) admission and mechanical ventilation, and ultimately lowering mortality rates associated with SARS-CoV-2 infection.