Right Heart Care In the Right Place

2023

Atrial fibrillation and heart failure are two of the major cardiovascular challenges of our time. It is important that these conditions are detected in time and treated according to guidelines. This is far from always the case. It is sometimes not clear that certain symptoms are caused by atrial fibrillation or heart failure, neither to the patient himself nor to health care providers. As a result, it sometimes takes a long time before someone receives the right treatment.
The chronic nature of heart diseases such as atrial fibrillation and heart failure also means that patients with these conditions are seen by many healthcare providers. To achieve this in a high-quality and transparent manner, optimal cooperation between the various care domains is necessary. It is important that the principle of right care in the right place (JZOJP) is applied. However, network care is complex and the effective organization of JZOJP by the right healthcare professional is still far from commonplace despite the many initiatives.

The origin
Better treatment of these conditions was a priority on the cardiovascular disease research agenda. This is why the Dutch Heart Foundation and ZonMw have started the thematic collaboration “Right Heart Care In the Right Place". By combining expertise, we want to detect as many people as possible with atrial fibrillation and heart failure early and treat them optimally. We are doing this in various ways: jointly setting up subsidy rounds to support regional collaborations, supporting a national support structure for the regions and overarching activities that contribute to knowledge development.

As part of Right Heart Care In the Right Place, the network program of the Dutch Society of Cardiology, NVVC Connect, together with involved network partners, facilitates an adequate national support structure for affiliated regional collaborations, or Connect regions. The Connect regions are supported and guided in, for example, preparing the subsidy application and they receive support during the implementation of the regional transmural agreements.

The research
The Right Heart Care In the Right Place consists of two forms of support:

the National Impulse: the aim is to set up a sustainable national support structure that stimulates and guides regions in the regional design and implementation of network care in the field of atrial fibrillation and heart failure
the Regional Impulse: the aim of the Regio-Impulse Cardiac Care is to support regional alliances, the Connect regions, in implementing regional transmural agreements. By bringing together the various care providers from the 3rd, 2nd and 1st line, these collaborative ventures jointly offer cardiological care for atrial fibrillation or heart failure more integrally and transmurally. In this way, the patient comes into contact with the healthcare provider who can best contribute to the care need at that moment. A maximum of 22 Connect regions can receive funding to implement the transmural agreements or to optimize the implementation in their region.

Collaborators

Funded

Contact person:

Anja de Bruin

adebruin@nvvc.nl

Principal investigators

Dr. Jan van Ramshorst

Voorzitter NVVC Connect

Anja de Bruin

Programmaleider Impuls Hartzorg

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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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AtheroNeth

2025

Atherosclerotic cardiovascular disease (ASCVD) is the main cause of mortality in Europe. During the last decades, successful strategies have been developed to treat ASCVD targeting traditional and novel risk factors leading to an unprecedented arsenal to reduce the cardiovascular disease burden. Unfortunately, current strategies are all aimed at adding novel therapeutic agents on top of the standard therapeutic moieties, adopting the one-size-fits-all dogma. This strategy has major limitations including unaddressed heterogeneity of patients, ignoring patients’ side-effects, lack of response to therapy and decreased compliance. With ATHERONETH, we aim to bring forward stratification tools that help to improve the prediction of the actual cardiovascular risk of individual patients, and in particular the pathophysiological mechanisms the contribute to this risk in the individual patient. This will allow clinicians to better tailor their therapeutic regimens.
The Research

Our main objective is to identify biological parameters that can be utilized to better stratify patients with atherosclerotic cardiovascular disease for improved and personalized prevention and treatment. Utilization can be reached by finding circulating biomarkers or imaging characteristics that reflect plaque phenotypes, underlying pathophysiology, and ASCVD incidence.
By combining frontline knowledge, clinical data resources and multimodal technologies, the consortium members will execute the following workplan.
1 - In ATHERONETH we will fine-tune the local phenotypic diversity of human plaques on a multi-omics level and define plaque types that associate with biology and clinical events. These plaque types will be associated with systemic read-outs (biomarkers).
2 - We will define systemic inflammatory and lipid metabolism related determinants of heterogeneity in plaque phenotype and ASCVD.
3 - We will utilise existing data from (large) cohorts to determine (epi)genetic, lipidomic/proteomic, and microbiome-related biomarkers of ASCVD and build algorithms that define subgroups of patients.
4 -We will study imaging parameters of plaque characteristics and inflammation that point to differential disease progression and potential treatment benefit.
The Origin
AtheroNeth leverages scientific power that was generated over the past decade by (inter)national research consortia. This consortium resulted from the DCVA exploration on atherosclerosis. Our vision for the future is to achieve a reduction in ASCVD-associated morbidity and mortality, an improvement in the quality of life for patients, and a reduction of the associated healthcare burden and costs.
Our program has a strong match with the challenges as reported in the “Nationale Hart en Vaat agenda” (National Cardiovascular Agenda) of the Dutch Heart Foundation. It is evident that the current proposal addresses the challenges “Oog voor verschillen” (Eye for differences) and “Behandel op maat” (Tailored treatment).

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