Check@Home

2022

In the Netherlands, there is no national approach for early detection of cardiovascular disease, kidney disease and type 2-diabetes in the general population, despite the social and economic impact of these disorders. The Check@Home consortium was founded to fill this gap and aims to lower the morbidity and mortality of cardiovascular disease, chronic kidney disease and type 2 diabetes by 25% in the next ten years, and thereby decrease the burden of these chronic diseases.

The Focus

Due to common risk factors such as high blood pressure, obesity and the aging population, the number of people suffering from cardiovascular disease, chronic kidney disease or type 2-diabetes is expected to increase excessively in 2030. A large proportion of people are not aware of having these diseases, as it is often present without overt symptoms. Fortunately, these chronic conditions can be detected at an early stage, allowing for adequate and early treatment to prevent (the progression of) these conditions and their complications. Check@Home aims to do so by developing a (cost-)effective national program that is accessible to all socio-economic groups and takes place in the citizen's own living environment, making it comfortable for citizens to do. It will also reduce the burden on primary care and contribute to the affordability and sustainability of healthcare. The program is designed and implemented in close collaboration with citizens, patients, and local citizen initiatives, to make sure that this program is a durable solution for all groups of society.

The Research

In total 160,000 people aged 50-75 years and living in Breda, Utrecht, Arnhem and Eindhoven, will be invited to participate in the study with a home-based test using the Check@Home digital platform. In case of early signs of cardiovascular disease, kidney damage or diabetes type 2, a targeted work-up will follow in a regional diagnostic center. If necessary, lifestyle advice and initiation of medication will be provided to relieve regular care as much as possible.

The Origin

At the request of several DCVA partners, including the Dutch Heart Foundation, which has earlier recognition of cardiovascular disease highly prioritized on its national research agenda, which was drawn up at the initiative of the Dutch Heart Foundation in 2014 and revised in 2020, the DCVA explored the potential for a national initiative to develop the first population screening for cardiovascular disease in 2020. The Check@Home study builds on previous studies, including the KidneyCheck study. To achieve a national approach to the early detection of diabetes, cardiovascular disease and chronic kidney damage, the DCVA, Dutch Heart Foundation, Dutch Kidney Foundation and Dutch Diabetes Fund established the Check@Home consortium. This is a collaboration of multiple research groups, private parties, and research funders: NWO, the Dutch Heart Foundation, the Dutch Kidney Foundation and the Dutch Diabetes Fund.

The projectcoördinators are Dr. Lyanne Kieneker and Dr. Stephanie van der Voorn.

Funded

Contact person:

Dr. Lyanne Kieneker

l.kieneker@dcvalliance.nl

Principal investigators

Prof. dr. Folkert Asselbergs

f.w.asselbergs@amsterdamumc.nl

Prof. dr. Ron Gansevoort

r.t.gansevoort@umcg.nl

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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.

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DEFENCE

2021

Currently, it is largely unknown to what extent the heart is involved in COVID-19. The aim of this project is to assess the incidence and consequences of cardiac damage in patients who have experienced COVID-19. How often does COVID-19 lead to myocardial damage? What are the short- and long-term consequences of this damage and what can we do to prevent it from occurring? These are the central questions that will be answered within the DEFENCE consortium.
The Research
The DEFENCE consortium integrates several national studies initiated at the onset of the COVID-19 pandemic, encompassing diverse patient groups as part of the COPP study, ranging from elite athletes (COMMIT study) and individuals recovering at home (COVID@Heart study) to hospitalized patients (CAPACITY-COVID registry and CAPACITY 2 study) and children with post-infection inflammatory syndromes affecting the heart (MIS-C). By harmonizing these initiatives, a unique cohort spanning the entire spectrum of COVID-19 severity has been established.
The ongoing studies are extended at multiple levels within the DEFENCE project. This includes:
Standardized Healthcare Pathway Implementation: Implementing and evaluating a standardized healthcare pathway to assess cardiac damage occurrence within 6 months post-hospitalization for COVID-19.
Serial Cardiac Magnetic Resonance (CMR) Imaging: Performing serial CMR imaging to determine the prevalence and reversibility of myocardial damage, with all scans assessed in a core lab.
Evaluation of Cardiovascular Symptoms: Assessing the incidence of cardiovascular symptoms such as chest pain and palpitations in the post-acute phase through patient questionnaires.
Linking Data to National Datasets: Linking study data to national datasets at Statistics Netherlands to analyze long-term cardiovascular morbidity and mortality. To evaluate whether cardiovascular disease is a characteristic feature of COVID-19, a comparison with other respiratory tract infections, including seasonal influenza will be made.






Origin
This research has is funded by ZonMw, but has been set up through the efforts of WCN, NLHI, NHR, the Dutch Heart Foundation, NVVC, NVIC, Harteraad, and the EuroQol Research Foundation, who collaborate within the Dutch CardioVascular Alliance.

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