RECONNEXT

Heart failure represents a significant healthcare challenge due to its high morbidity and mortality rates. Historically, the emphasis has been on heart failure with reduced ejection fraction characterized by left ventricular dilation. However, nearly half of heart failure patients involve diastolic dysfunction due to heart chamber stiffening, known as diastolic heart failure or HFpEF.

The Focus
Research conducted by our consortium indicates that impaired kidney function is an is a strong risk factor for HFpEF. Patients with chronic kidney disease are more prone to developing HFpEF and have higher mortality rates from associated complications. The specific mechanisms by which even slight declines in renal function worsen cardiovascular risk and impact the development and prognosis of HFpEF are not yet fully understood. Insights from RECONNECT highlight the pivotal role of systemic inflammation and microvasculature in this context.

The Research
RECONNEXT(Renal connection to microvascular disease and HFpEF: the next phase) is a multicenter consortium dedicated on advancing medical research on heart failure - particularly heart failure with preserved ejection fraction (HFpEF) - in relation to impaired kidney function.

RECONNEXT builds upon the success of RECONNECT, established in 2015 (see Figure 1 below). The RECONNEXT consortium consists of nephrologists, cardiologists, general practitioners, and scientists from five leading academic centers in the Netherlands (UMC Utrecht, Erasmus MC, UMC Groningen, Amsterdam UMC, Leiden University) renowned for their expertise in heart failure, vascular biology, and chronic kidney disease.

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Funded

Contact person:

info@heart-institute.nl

Principal investigators

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The RACE 9 Observe-AF

2020
Until recently the standard approach of patients with recent-onset atrial fibrillation (AF) involved early cardioversion. In the latest ESC AF guidelines, a delayed cardioversion approach within 48 hours has been added to the recommendations. However, given the self-terminating and recurrent nature of AF, cardioversion may not always be necessary, and rate control medication could suffice to manage symptoms until spontaneous conversion to sinus rhythm occurs. The Focus The RACE 9 Observe-AF trial is a multicenter, prospective, randomized, open-label non-inferiority trial comparing a watchful waiting strategy (intervention) to routine care (control) for patients with recent-onset symptomatic AF. The Research The watchful waiting approach involves symptom reduction through rate control medication and monitoring for four weeks to await possible spontaneous conversion to sinus rhythm. Routine care consists of either early or delayed cardioversion within 48 hours. The primary endpoint of this non-inferiority study is the presence of sinus rhythm on the ECG after four weeks. Several stakeholders and potential end-users are closely involved in defining the study deliverables. An end-user expert committee has been established, consisting of seven patients with a history of arrhythmias, a psychiatrist, a privacy and legal advisor, a cardiologist, an AF nurse, a general practitioner, and two experts in hospital technology implementation. This committee was involved in piloting the device-based rate and rhythm infrastructure, providing feedback for optimization before the study commencement. Additionally, the committee meets regularly to advise investigators on implementing the device-based infrastructure into daily clinical practice post-study. The study will be conducted across multiple centers in the Netherlands, including UMC Groningen, Radboud UMC, Amsterdam UMC, Alrijne Hospital, VieCuri Medical Centre, Zuyderland Medical Centre, Elisabeth-TweeSteden Hospital, Rijnstate Hospital, Martini Hospital, St. Antonius Hospital, Antonius Hospital, Noordwest Hospitalgroup, Medisch Spectrum Twente, and Maastricht University Medical Center.
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