CARE & PATIENT MANAGEMENT
Leaders: Athanase Benetos and Edoardo Camenzind
Objectives and resources:
The objectives of WP3 are to apply preventive, diagnostic and therapeutic interventions on the “life-long ageing process” on a population-based and an individual-based level via a pluri-disciplinary approach integrating additional factors related to CV co-morbidities such as chronic kidney disease (CKD) and metabolic disorders, as well as frailty, poly-medication and poly-morbidity in the elderly. The aim is to promote innovating diagnostic and therapeutic strategies integrating the comorbidities, frailty and other associated conditions. The achievement of this objective should lead to establishing a durable reference center for the maintenance of CV health and treatment of cardiovascular life-long ageing processes:
Task 1 : Set up of a Clinical Unit to assess, prevent and treat accelerated cardiovascular ageing (ACVA)
Our goal is to promote the needed adaptation of health care resources in the Lorraine region toward individuals with identified risk conditions for subsequent cardiovascular diseases. This multidisciplinary Unit (cardiovascular medicine and surgery, diabetes dept., nephrology, neurology and geriatrics) will perform standardized evaluations in the context of a day hospital dedicated to this activity.
We will propose this work-up to 3 groups of subjects at high risk for presenting ACVA:
- Multiple CV risk factors
- Established CV disease
- Cognitive decline
We assume that these groups can therefore benefit from preventive and therapeutic CV interventions. This evaluation will include the routine non- invasive CV evaluations recommended by the French health insurance together with hi-tech CV phenotyping using innovative biomarkers and diagnostic tools which have been largely developed and validated by several groups of our consortium.
- Organization of this Unit: definition of the business model (T2A rates and MIGAC reimbursement), day hospital, medical personnel, technicians.
- Definition of the biomarkers and diagnostic tools
- Clinical Research perspectives (Participation in clinical cohorts and clinical trials).
Task 2: Implementation, of a consultation of cardio-geriatrics to assess patients’ frailty and to determine an individualized management program to preserve autonomy and quality of life
The objective is to make the optimal choice of diagnostic and therapeutic strategies in order to avoid “ageism” (a priori exclusion because of advanced age) and aggressive therapies targeting only life prolongation. This task will be achieved by two means: first prioritizing quality of life and second, assessment of degree of frailty needed to:
- Establish a methodology of comprehensive geriatric assessment (CGA)
- Establish tools and strategies for the evaluation of quality of life.
- Assess the contribution of the “vascular component” in non-cardiovascular age-related diseases such as osteoporosis, renal failure, multiple falls and sarcopenia. Such clinical settings have already been tested via collaborations between the geriatric department and the departments of Endocrinology Osteoporosis (Pr Weryha), and Nephrology (Pr Frimat).
- Set up a weekly multidisciplinary staff meeting for the management of complex clinical cases (e.g. indications of specific therapeutic strategies such TAVI, renal replacement therapy, coronary, carotid, aortic stenting).
- Develop specific cardio-training programs for old frail patients in collaboration with the group of Pr. T. Vogel of the CHRU-Strasbourg.
- Specific programs for the health education and decision-making strategies for elderly patients and their caregivers aiming to preserve their autonomy, whilst improving health outcomes and quality of life.
Task 3. Development and application of novel cardiovascular therapeutic technologies to clinics
The goal is to offer a bridging translational organization from development to clinic allowing a structured and timely evaluation of novel device systems allowing:
- Further development and application of new techniques already used by partners of our consortium (minimal invasive surgical modalities e.g. use of robotics in surgery, percutaneous structural heart treatment and vascular treatment e.g. TAVI (Pr Maureira) and novel stent technologies (Pr Camenzind, Pr Malikov).
- Further development of postdoc educational programs using simulation models as well as animal models at the school of surgery to implement new treatment modalities to the clinics.
- Further development of telemedicine tools (tele-consultation, tele-assistance, domotics) for patients with cardiovascular, renal, metabolic and other chronic diseases in collaboration with GCS Télésanté Lorraine, Agence Régionale de Santé, Regional SMEs some of which have sprouted from research teams (CardioRenal diagnosticS, etc) and CARTAGE partnering disease management programs (e.g. for chronic kidney disease patients: Nephrolor, ALTIR; for diabetes: Maison du diabète; Geriatric Nancy and Metz Network, I. Volery).