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Heart failure (HF) is one of the most complex chronic disorders with high prevalence, mainly due to the ageing population and better treatment of underlying diseases. Prevalence will continue to rise and is estimated to reach 3% of the population in Western countries by 2025. It is the most important cause of hospitalisation in subjects aged 65 years or more, resulting in high costs and major social impact. The current “one-size-fits-all” approach in the treatment of HF does not result in best outcome for all patients. These facts are an imminent threat to good quality management of patients with HF. An unorthodox approach from a new vision on care is required. We propose a novel predictive, preventive and personalised medicine approach where patients are truly leading their management, supported by an easily accessible online application that takes advantage of artificial intelligence. This strategy paper describes the needs in HF care, the needed paradigm shift and the elements that are required to achieve this shift. Through the inspiring collaboration of clinical and high-tech partners from North-West Europe combining state of the art HF care, artificial intelligence, serious gaming and patient coaching, a virtual doctor is being created. The results are expected to advance and personalise self-care, where standard care tasks are performed by the patients themselves, in principle without involvement of healthcare professionals, the latter being able to focus on complex conditions. This new vision on care will significantly reduce costs per patient while improving outcomes to enable long-term sustainability of top-level HF care.

Aims The adherence to the guidelines for pharmacotherapy of chronic heart failure (HF)-patients improves prognosis. Although general practitioners (GPs) treat the majority of HF-patients, information about GPs’ current guideline adherence and their typical prescription rationales is sparse. Methods and results A three-stage study design was employed. In Stage I, 206 patient records from 15 randomly chosen GP practices were analysed; 76 % of patients were prescribed ACE-inhibitors or angiotensin receptor blockers (ACEIs/ARBs), 73 % beta blocker (BBs), but only 18 % mineralocorticoid receptor antagonists (MRAs). ACEI doses were at 62 % of the guideline recommended target doses, BBs at 46 %, while MRAs were sufficiently highly dosed. The guideline adherence indicator (GAI-3) was only 22 %. In Stage II, GPs in all 15 practices were interviewed, and health record documentation deficits and patients’ contraindications were taken into account. This increased the percentage of patients correctly prescribed ACEIs/ARBs to 87 %, BBs to 84 % and GAI-3 to 56 %. MRAs exhibited the most frequent contraindications, but remained underprescribed. Many GPs seemed not to be aware of the therapeutic value of MRAs or the need to reach target doses of the indicated drug classes. Patients—interviewed in Stage III—reported good tolerability of HF-drugs and generally good compliance, although 11 % discontinued HF-medication on their own. Conclusions Guideline adherence of GPs was higher than expected from literature and might be further improved by highlighting MRAs as the third prognostically relevant drug class beside ACEIs/ARBs and BBs and stronger emphasis on target doses.

Background In Europe, more than 15 million people live with heart failure (HF). It imposes an enormous social, organizational and economic burden. As a reaction to impending impact on healthcare provision, different country-specific structures for HF-care have been established. The aim of this report is to provide an overview and compare the HF-care approaches of Germany, Ireland, the Netherlands and the UK, and to open the possibility of learning from each other’s experience. Methods A mixed methods approach was implemented that included a literature analysis, interviews and questionnaires with HF-patients and caregivers, and expert interviews with representatives from healthcare, health service research and medical informatics. Results The models of HF-care in all countries analyzed are based on the European Society of Cardiology guidelines for diagnosis and treatment of HF. Even though the HF-models differed in design and implementation in practice, key challenges were similar: (i) unequal distribution of care between urban and rural areas, (ii) long waiting times, (iii) unequal access to and provision of healthcare services, (iv) information and communication gaps and (v) inadequate implementation and financing of digital applications. Conclusion Although promising approaches exist to structure and improve HF-care, across the four countries, implementation was reluctant to embrace novel methods. A lack of financial resources and insufficient digitalization making it difficult to adopt new concepts. Integration of HF-nurses seems to be an effective way of improving current models of HF-care. Digital solutions offer further opportunities to overcome communication and coordination gaps and to strengthen self-management skills.

Abstract Aims Heart failure (HF) is a major cause of hospitalization, mortality and healthcare costs. Reducing its socioeconomic burden is a key global public health priority. HF networks are recommended to improve screening and management of HF patients. We developed and implemented a multi-sectoral HF network in Northern Germany aimed at optimizing patient outcomes. Methods and results A regional HF network was established by integrating 12 pre-existing local networks into a state-wide, multi-sectoral HF network. Data from HF-coded patients were analysed for two time periods: pre-implementation (2018–2020) and post-implementation (2021–2023). Patient trajectories through the healthcare system were examined using both inpatient and outpatient datasets. We report on the network's implementation across urban, island and rural areas, along with associated challenges and benefits. A roadmap of HF patient trajectories was created, identifying key healthcare entry points and informing a three-pillar theory of change to address the national HF burden. Post-implementation, outpatient treatment cases increased markedly (2018–2020 n = 1237 vs. 2021–2023 n = 2563; +101.3%, P < 0.001), as did referrals from specialists (2018–2020 n = 290 vs. 2021–2023 n = 434, +49.7%, P = 0.013), general practitioners (2018–2020 n = 369 vs. 2021–2023 n = 435, +17.9%, P = 0.26), and inpatient admissions (2018–2020 n = 2342 vs. 2021–2023 n = 2608, +20.7%, P = 0.03). HF rehospitalization rates showed no significant difference yet despite a positive trend (2018–2020 20.3% vs. 2021–2023 17.9%; P = 0.295), while in-hospital mortality remained stable (2018–2020 8.8% vs. 2021–2023 10.2%; P = 0.1). Conclusions Implementation of a novel multi-sectoral HF network enabled the analysis of patient trajectories and identification of areas for improvement in HF care. Observed shifts in referral patterns and increased treatment activity indicate early positive trends that support the potential of such networks in enhancing HF management and reducing disease burden.

Background Patient-reported outcome and experience measures (PROMs and PREMs) are increasingly acknowledged as vital instruments for assessing the quality of care for cardiovascular diseases (CVD). These measures include validated and non-validated questionnaires, interview guides, and workshops, which differ in terms of their structure, reliability, and application. Currently, there is no overview of which patient-reported outcomes and experiences are measured in CVD research and care, and there is limited consensus on how PROMs and PREMs are selected and applied. Methods A scoping review was conducted in accordance with the PRISMA extension for scoping reviews, with the aim of systematically identifying and analysing studies that report on the use of PROMs and PREMs in CVD. Literature searches were performed in PubMed and ClinicalTrials.gov for studies published before April 2024. Studies assessing patients with heart diseases (ICD-10: I20–I25; I34–I37; I42; I46–I49; I50) using conventional or digital measures to evaluate care quality from the patient’s perspective were included. Studies focusing on CVDs stemming from neurological complications, rheumatic disease, birth defects, and peripheral artery disease were excluded. The same applies to studies using non-validated PROMs. Data analysis was conducted using qualitative content analysis. Results Of the 5,489 records identified, 390 publications were included for full-text analysis. More than a third of these were observational studies ( n  = 168; 43%). PROMs were used more frequently than PREMs (309 vs. 159 studies). Quality of life was the most measured patient-reported outcome (211 of 309 studies; 68%), followed by health status ( n  = 110; 36%) and depression ( n  = 105; 34%). A total of 540 instances of PROM application were recorded across the 390 identified studies, representing 140 unique measurement instruments. More than half of these are disease-specific ( n  = 443; 57%), particularly for heart failure, the condition most frequently studied. Of the 140 different PROMs identified, 26 were used in more than five studies, indicating that while many tools exist, only a small subset are in common use. Of the 166 PREMs identified, 57% ( n  = 94) were self-developed questionnaires or interview guides, predominantly used in qualitative studies. Validated PREMs often do not focus on a specific disease. The most frequently assessed patient-reported experiences were self-care, treatment experiences, satisfaction, knowledge, and adherence. Both patient-reported outcomes and experiences were primarily assessed using paper-based measures. Conclusion This review highlights the lack of consensus in the use, validation status and reporting of PROMs and PREMs in CVD research and care. Although validated, disease-specific PROMs are widely used for key outcomes such as quality of life, there is a lack of standardised PREMs tailored to CVDs. To advance patient-centred care in CVDs, there is a need for more consistent use of validated instruments, transparent reporting of administration methods, and the development of robust PREMs. Furthermore, standardising the PROMs and PREMs used may help, particularly with regard to the comparability of findings in different studies.

Background Heart failure (HF) is a chronic disease characterized by high mortality and healthcare expenditures. Digital health solutions, including mobile health applications (apps), offer opportunities to enhance patients’ self-care and quality of life. This qualitative study aimed to explore expectations, experiences, and usage behaviour of HF-patients regarding a self-care app (DoctorME app). Methods Semi-structured interviews were conducted at 2-3 weeks (initial: n = 38), and 4–6 months (post: n = 45) of app use across four European countries. Most patients were male (initial: 84%; post: 78%), aged 60–69 years (initial and post: 29%), with mild HF symptoms. Interviews were transcribed, pseudonymised, and analysed using qualitative content analysis. Results Five key themes were identified: 1) expectations, 2) perceived usability and benefit, 3) usage behaviour and experiences, 4) self-care, and 5) social influences. Patients expected and valued continuous monitoring of vital signs and weight, early detection of deterioration, and quick feedback. The app was considered user-friendly, with most patients using it as recommended (eight times per month). Those reporting improved self-care attributed it to increased awareness and a sense of security. Patients with established self-care routines did not perceive any additional benefit. Patients’ perceptions on the impact of healthcare professionals’ and relatives opinions on app use were divided. Conclusions User-friendliness, continuous monitoring, rapid feedback, and e-learning modules are crucial for integrating self-care apps into daily HF care. While technical reliability and individualisation may enhance long-term use, most HF patients considered the app as a complement to, not a replacement for, professional healthcare guidance.

Background: We have recently shown that ischemic stroke causes a stress-mediator-induced long-lasting immunodepressive state in mice. Methods: Using head magnetic resonance imaging and standardized immunoassays, we prospectively investigated whether poststroke immunodepression is also seen in humans. Results: Compared to healthy volunteers (n = 30), a rapid depression of lymphocyte counts and a functional deactivation of monocytes and T helper type 1 cells was observed in acute stroke patients (SP; n = 40). Immunodepression was more pronounced in patients with severe clinical deficit or large infarction. On admission the combination of monocytic tumor necrosis factor α release ex vivo and the National Institute of Health Stroke Scale score were the best predictors for nosocomial infection, preferentially affecting older SP. Conclusion: Our data provide evidence for an immediate suppression of cell-mediated immune responses after ischemic stroke in humans.

IntroductionCardiovascular disease (CVD) represents a public health burden, with high prevalence and significant morbidity and mortality. Although evidence-based interventions exist, there is a need for more individualised care. The European project Individualised care from early risk of cardiovascular disease to established heart failure (iCARE4CVD) aims to personalise CVD prevention and treatment. Participatory health research, which actively involves patients in the planning, implementation and evaluation of projects, plays a crucial role here. However, patient participation is often unsuccessful due to the lack of a representative patient sample who is involved throughout the project’s duration, has knowledge of the project and can contribute their experience.Methods and analysisParticipative Research for Individualised Care in Cardiovascular Diseases is a non-interventional, non-randomised, multicentre mixed-methods study. The aim is to incorporate patients’ insights into several key activities within iCARE4CVD by establishing country-specific patient panels in Belgium, Germany, Ireland and the UK. The primary objective is to identify patients’ preferences, experiences, requirements and needs for better diagnosis, treatment and self-care of CVD. Therefore, 10–12 patients across the CVD spectrum, from early risk to established CVD and heart failure, will be included in each country (40–48 in total). Over 3.5 years, patient panel members are required to complete four tasks: (1) identification of meaningful Patient-Reported Outcome and Experiences Measures, (2) development of a motivational model to increase adherence, (3) feedback on CVD care processes and (4) usability testing of new digital tools developed within iCARE4CVD. These tasks comprise eight activities in the form of paper-based or digital exercises, telephone surveys, written surveys and in-person focus groups. The results will be continuously incorporated into iCARE4CVD.Ethics and disseminationThis study received ethical approval by the Ethics Committee at the Faculty of Medicine of RWTH Aachen University (EK 24-172) and St. Vincent’s University Hospital (RS24-027), Research Ethics Committee. In Geel and Belfast, positive ethics approval is pending. All participants will provide written informed consent prior to enrolment in the study and participation in the first patient panel task. Results will be published in peer-reviewed journals and presented at scientific conferences.Trial registration numberDRKS00034899.Protocol versionV2.1, 6 June 2024.