Interview with Hein Heidbuchel (UZA) - Scientific Coordinator
Please tell us a bit about yourself
I am an academic electrophysiologist, with a career that started in cellular electrophysiology and single ion channel recordings and evolved into the full scale of ablations. I was also the first to implant left ventricular epicardial leads and CRT-systems in Belgium. Despite evolving into more administrative tasks over the last years (the privilege of aging…) I try to keep contact with daily clinical practice. As Chair of Cardiology at the University Hospital Antwerp, Belgium, I have a full plate of tasks: research, teaching, managing, and clinical work. Nevertheless, I like the taste of it!
Please tell us more about your organisation
The EHRA-PATHS consortium was formed during my two years as EHRA President. On one hand, I wanted that EHRA and ESC evolved towards the coordinators of a European research consortium. On the other hand, as a member of atrial fibrillation guideline committees, I together with many others realised that comorbidities are very important for the treatment of patients with atrial fibrillation, we all struggle to deal with those in daily practice. Therefore, each of the 13 partners of the consortium consists not only of a Cardiology department, but also of another department, like pneumology, neurology, nephrology, up to general medicine. This is a unique consortium, truly multidisciplinary.
What is your role in the project?
I am the scientific coordinator. Although ERHA and ESC officially coordinate the consortium, they have no scientists as employees. However, they have all the best experts in the field as members. As a volunteer member of EHRA, I take up the scientific coordination of the consortium, ensuring together with a management team, the efficient rollout of all the work packages of the project, while overseeing its overall goals.
When did you get involved in EHRA-PATHS?
The basic idea originated from research in my team, which connected to research of many other colleagues throughout Europe. Therefore, together with my post-doctoral collaborator Lien Desteghe, we wrote a first draft synopsis of the project, and later, after discussions with the other consortium members and in collaboration with the consulting company, Catalyze, we wrote the full proposal. Already at that stage, I scientifically coordinated the contributions of the different consortium partners into a consolidated research plan. Apparently, that plan caught on, since we got financial funding in the Horizon2020 program at its first submission. Together with Lien, we are also responsible for work packages 3 and 4 of the project.
Can you describe your work and how it is related to EHRA-PATHS?
As scientific coordinator, I keep a constant eye on the progress of all the work packages. I contact the different work package coordinators when needed, and provide feedback on their questions. The whole project has a strict timeline, which requires permanent guarding and motivation of all collaborators. Luckily, we do this as a Management Team, with bi-weekly teleconferences. Scientifically, I am supported by Isabelle Van Gelder from Groningen and Lien Desteghe. In that team also EHRA/ESC and Catalyze have their specific roles, like communication with the European Commission, setting up all external and internal communication, administration of reports, deliverables and meetings. I also chair 3-monthly Steering Committee meetings in which all the work package coordinators and representatives from the consortium partners convene to discuss the progress of the project. I must say that working with the Management team and Steering Committee is a wonderful experience, with a great collaborative spirit.
How can EHRA-PATHS contribute to improving the lives of elderly atrial fibrillation patients with multimorbidity?
The treatment, effectiveness and outcome of patients with atrial fibrillation is largely defined by the underlying comorbidities. On average, elderly patients with atrial fibrillation have 4-5 comorbidities. Many of those lie outside the cardiovascular field. Keeping track of their detection, management, and multidisciplinary follow up, requires better tools. That is exactly the goal of this project. We will develop such tools, and test in a randomised clinical trial whether their use effectively improves comorbidity management.
What has been the most successful part of your work in EHRA-PATHS?
So far we are sticking to our preset tight timeline, which makes me very proud. We have analysed large databases to understand better the scope of multimorbidity and its impact on outcome in patients with atrial fibrillation. We have explored the current gaps in multimorbidity management, both by looking at the patient’s side and to the side of the healthcare team. We have defined 22 comorbidities, and developed care pathways to diagnose and manage those. We are in the full development of a new software tool that integrates these pathways, while the team from the University of Groningen is well on track to submit the documents to start the clinical trial which is due in the second half of 2023.
What are the main challenges in your work in EHRA-PATHS?
To keep things simple! When you have to develop care pathways for >20 comorbidities, the major threat is that each of those becomes too complex, making the whole approach unworkable. That requires a delicate balancing between refinement and simplicity. That is a very frustrating new paradigm for experts who are used to dealing with complexities in their respective subspecialties. But overall, I think that we are very well on track.
What are the still unknown research questions in multimorbidity in elderly atrial fibrillation patients?
For many comorbidities, we know that their presence is related to the arrhythmic and clinical outcome. For many, however, prospective data are lacking that correction of the comorbidity indeed leads to improved prognosis, how plausible that may be. This explains why within the consortium, we noted varying views on the priority to deal with each of the different comorbidities.
For many of the comorbidities, it is also unknown what is the best format of the care pathway to detect and manage that comorbidity. We have presented such care pathways, but I am convinced that for many of those, future research will show improvements in efficiency, impact and cost effectiveness.
I will be very happy for our consortium if it succeeds in getting multimorbidity management on the rails in the first place, offering all sorts of opportunities for improvements later!
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