The Comprehensive Heart Failure Centre in Würzburg, Germany

The Comprehensive Heart Failure Centre in Würzburg, Germany The Comprehensive Heart Failure Centre in Würzburg (Deutsches Zentrum für Herzinsuffizienz) is a new Integrated Research and Treatment Centre for the Prevention of Heart Failure and its Complications  Life expectancy of patients with cardiovascular diseases has increased considerably during the last decades. More patients survive acute cardiac diseases (e.g. acute myocardial infarction) but are left with severe structural damage of the heart and prone to develop heart failure (HF), which thus has become an epidemic of the 21st century. Despite substantial progress in therapy, mortality and morbidity have remained high and guidelines report numerous evidence gaps for HF management.1,2 Controlled outcome studies for diagnostics are virtually absent, therapies of acute HF and HF with preserved ejection fraction have remained unsettled, and recommendations for end-stage HF and for many surgical procedures are expert opinions. The importance of comorbidities and end-of-life care is increasingly recognized but calls for new approaches to research in areas such as health services, public health, and guideline implementation. Finally, one therapy will not fit all types of HF, which varies regarding aetiology, genetic background and profile of comorbidities and complications. Due to this complexity, research and patient care require a comprehensive approach with translational and interdisciplinary networking. Translational analysis of mechanisms leading to HF demands collaboration of basic and clinical research, and multi-organ involvement requires co-operation among diverse clinical disciplines. Objectives Led by Georg Ertl, a group of scientists with complementary interests in various fields of cardiovascular research (Figure 1) joined forces at Würzburg University and acquired funding for a ‘Comprehensive Heart Failure Centre’ (CHFC) from the Federal Ministry for Education and Research (BMBF), which was granted in 2011. The CHFC aims to integrate research and patient care for the ‘Prevention of Heart Failure and its Complications’. A novel, unique and most promising component of the concept was interlinking cardiovascular science with disciplines previously not or not specifically concerned with HF (horizontal networking) across scientific approaches, ranging from population-based and health care research to translational and basic science (vertical networking) (Figure 2). Figure 1 View largeDownload slide The initiators of the Comprehensive Heart Failure Centre Würzburg (from left to right): Georg Ertl, MD; Christiane E. Angermann, MD; Martin Lohse, MD, PhD; Stefan Frantz, MD; and Stefan Störk, MD, PhD. Figure 1 View largeDownload slide The initiators of the Comprehensive Heart Failure Centre Würzburg (from left to right): Georg Ertl, MD; Christiane E. Angermann, MD; Martin Lohse, MD, PhD; Stefan Frantz, MD; and Stefan Störk, MD, PhD. Figure 2 View largeDownload slide Horizontal and vertical networking at the Comprehensive Heart Failure Centre Würzburg interlinks cardiovascular research with other clinical disciplines previously not or not specifically concerned with HF (horizontal networking) across different scientific approaches, ranging from basic and translational to population-based and health care research (vertical networking). Figure 2 View largeDownload slide Horizontal and vertical networking at the Comprehensive Heart Failure Centre Würzburg interlinks cardiovascular research with other clinical disciplines previously not or not specifically concerned with HF (horizontal networking) across different scientific approaches, ranging from basic and translational to population-based and health care research (vertical networking). The CHFC established central structures and platforms for interdisciplinary communication, co-operation, patient care, new forms of education, training and career promotion under one roof, and—most importantly—attracts creative people dedicated to excellence and enthusiastic to look beyond the borders of their own discipline. An efficient management and governance structure was implemented with flat hierarchies and high acceptance in the various disciplines. Transparent and consented procedures provide non-bureaucratic and strictly quality-oriented allocation of resources. While research centres as well as specific teaching and training modules were traditionally well established for basic and translational research at the Würzburg University Campus, the CHFC is now expanding respective facilities also to clinical research. Structural development To enable these novel approaches to HF research and care, the CHFC fosters collaborations between basic research institutes (e.g. physiology, physics, anatomy, pharmacology, and epidemiology) with clinical departments and, rather unique in HF research, cardiologists interface with a broad range of clinical disciplines (e.g. nephrology, endocrinology, neurology, psychiatry, oncology, immunology, cardiothoracic surgery, imaging). The long-standing strong research performance of institutes and clinics of the University and University Hospital were key to obtain funding for the CHFC. In turn, the CHFC was instrumental in establishing the Interdisciplinary Biomaterial and Data Bank Würzburg (IBDW) as part of the BMBF-funded National Biobank Initiative. Meanwhile, the CHFC has prospered into a central hub for co-operation with external research structures such as the German Competence Network Heart Failure. An important milestone was that a dedicated building for research and patient care was awarded to the CHFC in a national competition. In 2017, central units, core facilities, multidisciplinary research groups, and outpatient services moved into this trend-setting new building tailored to the specific needs of the CHFC. It houses high-tech clinical as well as small and large animal imaging facilities, experimental laboratories, and patient care facilities. Core Facilities support research and patient care. The CHFC includes a Clinical Research Centre housing multidisciplinary outpatient clinics, which also provide comprehensive resources for planning and conducting clinical studies and an Epidemiological Survey Unit. Core Facilities for Translational Imaging, Genetics, Cellular Electrophysiology, Mitochondrial Function, Regenerative Medicine, Medical Information System Based Access to Patient Data, and the Centre for Experimental Molecular Medicine provide excellent equipment and services for a broad spectrum of research. Therefore, the CHFC facilitates unique co-operative structures for research among various disciplines and clinical epidemiology. The CHFC has also conceived and promoted new programs in clinical research for students and junior scientists and established training programs for nurses and junior staff in the specific needs of HF patients and in cardiac imaging. It trains increasing numbers of CHFC scientists, physicians, and nurses in these programs. New educational programs and new career paths offer undergraduate courses and a PhD programme for clinical research, rotational positions, and Junior Groups, thus attracting and promoting junior staff. Four Departments and Research Professor positions have attracted excellent researchers from outside, i.e., Brenda Gerull as the Head of ‘Genetics of Heart Failure’, Laura Schreiber for the Chair of ‘Molecular and Cellular Imaging’, and Christoph Maack (Figure 3) for the Chair of ‘Translational Research’, who has now succeeded Georg Ertl as the CHFC Speaker. They also offered excellent internal staff the opportunity of receiving tenure, such as Stefan Störk (Figures 1 and 3), who now holds the Research Professorship for ‘Epidemiology of Heart Failure’ and heads the Clinical Research Unit of the CHFC. After leaving the CHFC to adopt the Chair of Cardiology in Halle in 2014, Stefan Frantz (Figure 1) returned to Würzburg in 2017, where he is now holding the Chair of Internal Medicine and Cardiology as an essential partner of the CHFC (Figure 4). Figure 3 View largeDownload slide In 2017, the four Departments and Research Professorships at the Comprehensive Heart Failure Centre Würzburg (CHFC) moved into the new CHFC building. Figure 3 View largeDownload slide In 2017, the four Departments and Research Professorships at the Comprehensive Heart Failure Centre Würzburg (CHFC) moved into the new CHFC building. Figure 4 View largeDownload slide Comprehensive Heart Failure Centre Würzburg_©_Daniel Oppelt. Figure 4 View largeDownload slide Comprehensive Heart Failure Centre Würzburg_©_Daniel Oppelt. Three main Project Areas—‘Myocardium’, ‘Heart & Brain’, and ‘Heart, Metabolism & Other Organs’—support communication and co-operation among cognate projects and help to structure and focus CHFC research activities (Figure 5). Associated groups co-operate in the CHFC, are entitled to use the central facilities and contribute to a core team managing and expanding the CHFC, running central units, promoting research, and mentoring junior staff. Figure 5 View largeDownload slide Concept and organizational structure of the Comprehensive Heart Failure Centre Würzburg (CHFC). Research activities of multiple Central Units, dedicated Comprehensive Heart Failure Centre Würzburg CHFC research, educational, and public outreach facilities and professorships contribute to advancing science in the three main Project Areas (see text for more details). Figure 5 View largeDownload slide Concept and organizational structure of the Comprehensive Heart Failure Centre Würzburg (CHFC). Research activities of multiple Central Units, dedicated Comprehensive Heart Failure Centre Würzburg CHFC research, educational, and public outreach facilities and professorships contribute to advancing science in the three main Project Areas (see text for more details). The CHFC has also launched a network of regional hospitals and office-based physicians to improve cardiac care in the community. Public outreach is strengthened by dedicated staff, and the CHFC has a proven impact on health care by promoting certification of HF networks (HF-NETs) and HF-Units by the German Cardiac Society3 and is lobbying for the reimbursement by health insurances of a nation-wide HF disease management programme. Furthermore, public outreach was professionalized for better promotion of the awareness of HF and the CHFC. Research development The CHFC facilitates research with the potential to fill major gaps in knowledge on HF. A strong focus lies on the advancement of cardiovascular imaging by applying cutting-edge technology (such as animal and human PET-CT and 7T-MRI) to address novel mechanistic hypotheses. Using multi-modal and advanced imaging in both, animal models and patients, past and ongoing projects focus on how to reduce the risk of cardiac disease progressing to HF, how to stop transition from early to advanced stages, and how to fight complications of HF and its comorbidities. Registries were launched to define the risk of HF in the general population, but also in patients hospitalized for acute HF. Resources were acquired for a diagnostic study on the value of MRI vs. cardiac catheterization in HF. Therapeutic principles were challenged and their modes of action analysed in a translational approach.4,5 For instance, in a multi-centre randomized controlled trial performed jointly by cardiologists and psychiatrists (MOOD-HF), the selective serotonin reuptake inhibitor escitalopram was proven inefficient regarding both depression and improvement of clinical endpoints in patients with HF, questioning its use in such populations.5 Furthermore, various frequent comorbidities are addressed, and new therapeutic principles evaluated.6,7 Meanwhile, the CHFC has become a recognized reference centre for Fabry Disease and other rare cardiomyopathies,8,9 has associated and initiated multidisciplinary studies, and acquired national leadership in large multi-centre trials (e.g. REPORT-HF10, COMPASS,11 or REVEAL12). The Interdisciplinary Network Heart Failure (INH) Study initiated and validated a disease management programme for HF, which is meanwhile also accredited by the German Cardiac Society.3 Thus, vertical networking fosters translational research, and horizontal networking facilitates multidisciplinary research endeavours, thereby advancing patient care. In future research, a special focus will lie on the basic mechanisms of hereditary cardiomyopathies, metabolic, and epigenetic aspects of HF pathophysiology and the role of inflammation for cardiac remodelling. The CHFC educational and awareness campaigns reach out to the public regionally and nationally. A major future task will be to transfer these comprehensive concepts and structures into the general health care system. Funding The authors report funding of the CHFC by the Federal Ministry for Education and Research (BMBF, grants 01EO1004 and 01EO1504). The CHFC building was funded by the Free State of Bavaria, supported by federal funds according to article 91b of the Basic Constitutional Law of the Federal Republic of Germany. Conflict of interest: none declared. References References are available as supplementary material at European Heart Journal online. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal Oxford University Press

The Comprehensive Heart Failure Centre in Würzburg, Germany

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Oxford University Press
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.
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0195-668X
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1522-9645
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10.1093/eurheartj/ehy202
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Abstract

The Comprehensive Heart Failure Centre in Würzburg (Deutsches Zentrum für Herzinsuffizienz) is a new Integrated Research and Treatment Centre for the Prevention of Heart Failure and its Complications  Life expectancy of patients with cardiovascular diseases has increased considerably during the last decades. More patients survive acute cardiac diseases (e.g. acute myocardial infarction) but are left with severe structural damage of the heart and prone to develop heart failure (HF), which thus has become an epidemic of the 21st century. Despite substantial progress in therapy, mortality and morbidity have remained high and guidelines report numerous evidence gaps for HF management.1,2 Controlled outcome studies for diagnostics are virtually absent, therapies of acute HF and HF with preserved ejection fraction have remained unsettled, and recommendations for end-stage HF and for many surgical procedures are expert opinions. The importance of comorbidities and end-of-life care is increasingly recognized but calls for new approaches to research in areas such as health services, public health, and guideline implementation. Finally, one therapy will not fit all types of HF, which varies regarding aetiology, genetic background and profile of comorbidities and complications. Due to this complexity, research and patient care require a comprehensive approach with translational and interdisciplinary networking. Translational analysis of mechanisms leading to HF demands collaboration of basic and clinical research, and multi-organ involvement requires co-operation among diverse clinical disciplines. Objectives Led by Georg Ertl, a group of scientists with complementary interests in various fields of cardiovascular research (Figure 1) joined forces at Würzburg University and acquired funding for a ‘Comprehensive Heart Failure Centre’ (CHFC) from the Federal Ministry for Education and Research (BMBF), which was granted in 2011. The CHFC aims to integrate research and patient care for the ‘Prevention of Heart Failure and its Complications’. A novel, unique and most promising component of the concept was interlinking cardiovascular science with disciplines previously not or not specifically concerned with HF (horizontal networking) across scientific approaches, ranging from population-based and health care research to translational and basic science (vertical networking) (Figure 2). Figure 1 View largeDownload slide The initiators of the Comprehensive Heart Failure Centre Würzburg (from left to right): Georg Ertl, MD; Christiane E. Angermann, MD; Martin Lohse, MD, PhD; Stefan Frantz, MD; and Stefan Störk, MD, PhD. Figure 1 View largeDownload slide The initiators of the Comprehensive Heart Failure Centre Würzburg (from left to right): Georg Ertl, MD; Christiane E. Angermann, MD; Martin Lohse, MD, PhD; Stefan Frantz, MD; and Stefan Störk, MD, PhD. Figure 2 View largeDownload slide Horizontal and vertical networking at the Comprehensive Heart Failure Centre Würzburg interlinks cardiovascular research with other clinical disciplines previously not or not specifically concerned with HF (horizontal networking) across different scientific approaches, ranging from basic and translational to population-based and health care research (vertical networking). Figure 2 View largeDownload slide Horizontal and vertical networking at the Comprehensive Heart Failure Centre Würzburg interlinks cardiovascular research with other clinical disciplines previously not or not specifically concerned with HF (horizontal networking) across different scientific approaches, ranging from basic and translational to population-based and health care research (vertical networking). The CHFC established central structures and platforms for interdisciplinary communication, co-operation, patient care, new forms of education, training and career promotion under one roof, and—most importantly—attracts creative people dedicated to excellence and enthusiastic to look beyond the borders of their own discipline. An efficient management and governance structure was implemented with flat hierarchies and high acceptance in the various disciplines. Transparent and consented procedures provide non-bureaucratic and strictly quality-oriented allocation of resources. While research centres as well as specific teaching and training modules were traditionally well established for basic and translational research at the Würzburg University Campus, the CHFC is now expanding respective facilities also to clinical research. Structural development To enable these novel approaches to HF research and care, the CHFC fosters collaborations between basic research institutes (e.g. physiology, physics, anatomy, pharmacology, and epidemiology) with clinical departments and, rather unique in HF research, cardiologists interface with a broad range of clinical disciplines (e.g. nephrology, endocrinology, neurology, psychiatry, oncology, immunology, cardiothoracic surgery, imaging). The long-standing strong research performance of institutes and clinics of the University and University Hospital were key to obtain funding for the CHFC. In turn, the CHFC was instrumental in establishing the Interdisciplinary Biomaterial and Data Bank Würzburg (IBDW) as part of the BMBF-funded National Biobank Initiative. Meanwhile, the CHFC has prospered into a central hub for co-operation with external research structures such as the German Competence Network Heart Failure. An important milestone was that a dedicated building for research and patient care was awarded to the CHFC in a national competition. In 2017, central units, core facilities, multidisciplinary research groups, and outpatient services moved into this trend-setting new building tailored to the specific needs of the CHFC. It houses high-tech clinical as well as small and large animal imaging facilities, experimental laboratories, and patient care facilities. Core Facilities support research and patient care. The CHFC includes a Clinical Research Centre housing multidisciplinary outpatient clinics, which also provide comprehensive resources for planning and conducting clinical studies and an Epidemiological Survey Unit. Core Facilities for Translational Imaging, Genetics, Cellular Electrophysiology, Mitochondrial Function, Regenerative Medicine, Medical Information System Based Access to Patient Data, and the Centre for Experimental Molecular Medicine provide excellent equipment and services for a broad spectrum of research. Therefore, the CHFC facilitates unique co-operative structures for research among various disciplines and clinical epidemiology. The CHFC has also conceived and promoted new programs in clinical research for students and junior scientists and established training programs for nurses and junior staff in the specific needs of HF patients and in cardiac imaging. It trains increasing numbers of CHFC scientists, physicians, and nurses in these programs. New educational programs and new career paths offer undergraduate courses and a PhD programme for clinical research, rotational positions, and Junior Groups, thus attracting and promoting junior staff. Four Departments and Research Professor positions have attracted excellent researchers from outside, i.e., Brenda Gerull as the Head of ‘Genetics of Heart Failure’, Laura Schreiber for the Chair of ‘Molecular and Cellular Imaging’, and Christoph Maack (Figure 3) for the Chair of ‘Translational Research’, who has now succeeded Georg Ertl as the CHFC Speaker. They also offered excellent internal staff the opportunity of receiving tenure, such as Stefan Störk (Figures 1 and 3), who now holds the Research Professorship for ‘Epidemiology of Heart Failure’ and heads the Clinical Research Unit of the CHFC. After leaving the CHFC to adopt the Chair of Cardiology in Halle in 2014, Stefan Frantz (Figure 1) returned to Würzburg in 2017, where he is now holding the Chair of Internal Medicine and Cardiology as an essential partner of the CHFC (Figure 4). Figure 3 View largeDownload slide In 2017, the four Departments and Research Professorships at the Comprehensive Heart Failure Centre Würzburg (CHFC) moved into the new CHFC building. Figure 3 View largeDownload slide In 2017, the four Departments and Research Professorships at the Comprehensive Heart Failure Centre Würzburg (CHFC) moved into the new CHFC building. Figure 4 View largeDownload slide Comprehensive Heart Failure Centre Würzburg_©_Daniel Oppelt. Figure 4 View largeDownload slide Comprehensive Heart Failure Centre Würzburg_©_Daniel Oppelt. Three main Project Areas—‘Myocardium’, ‘Heart & Brain’, and ‘Heart, Metabolism & Other Organs’—support communication and co-operation among cognate projects and help to structure and focus CHFC research activities (Figure 5). Associated groups co-operate in the CHFC, are entitled to use the central facilities and contribute to a core team managing and expanding the CHFC, running central units, promoting research, and mentoring junior staff. Figure 5 View largeDownload slide Concept and organizational structure of the Comprehensive Heart Failure Centre Würzburg (CHFC). Research activities of multiple Central Units, dedicated Comprehensive Heart Failure Centre Würzburg CHFC research, educational, and public outreach facilities and professorships contribute to advancing science in the three main Project Areas (see text for more details). Figure 5 View largeDownload slide Concept and organizational structure of the Comprehensive Heart Failure Centre Würzburg (CHFC). Research activities of multiple Central Units, dedicated Comprehensive Heart Failure Centre Würzburg CHFC research, educational, and public outreach facilities and professorships contribute to advancing science in the three main Project Areas (see text for more details). The CHFC has also launched a network of regional hospitals and office-based physicians to improve cardiac care in the community. Public outreach is strengthened by dedicated staff, and the CHFC has a proven impact on health care by promoting certification of HF networks (HF-NETs) and HF-Units by the German Cardiac Society3 and is lobbying for the reimbursement by health insurances of a nation-wide HF disease management programme. Furthermore, public outreach was professionalized for better promotion of the awareness of HF and the CHFC. Research development The CHFC facilitates research with the potential to fill major gaps in knowledge on HF. A strong focus lies on the advancement of cardiovascular imaging by applying cutting-edge technology (such as animal and human PET-CT and 7T-MRI) to address novel mechanistic hypotheses. Using multi-modal and advanced imaging in both, animal models and patients, past and ongoing projects focus on how to reduce the risk of cardiac disease progressing to HF, how to stop transition from early to advanced stages, and how to fight complications of HF and its comorbidities. Registries were launched to define the risk of HF in the general population, but also in patients hospitalized for acute HF. Resources were acquired for a diagnostic study on the value of MRI vs. cardiac catheterization in HF. Therapeutic principles were challenged and their modes of action analysed in a translational approach.4,5 For instance, in a multi-centre randomized controlled trial performed jointly by cardiologists and psychiatrists (MOOD-HF), the selective serotonin reuptake inhibitor escitalopram was proven inefficient regarding both depression and improvement of clinical endpoints in patients with HF, questioning its use in such populations.5 Furthermore, various frequent comorbidities are addressed, and new therapeutic principles evaluated.6,7 Meanwhile, the CHFC has become a recognized reference centre for Fabry Disease and other rare cardiomyopathies,8,9 has associated and initiated multidisciplinary studies, and acquired national leadership in large multi-centre trials (e.g. REPORT-HF10, COMPASS,11 or REVEAL12). The Interdisciplinary Network Heart Failure (INH) Study initiated and validated a disease management programme for HF, which is meanwhile also accredited by the German Cardiac Society.3 Thus, vertical networking fosters translational research, and horizontal networking facilitates multidisciplinary research endeavours, thereby advancing patient care. In future research, a special focus will lie on the basic mechanisms of hereditary cardiomyopathies, metabolic, and epigenetic aspects of HF pathophysiology and the role of inflammation for cardiac remodelling. The CHFC educational and awareness campaigns reach out to the public regionally and nationally. A major future task will be to transfer these comprehensive concepts and structures into the general health care system. Funding The authors report funding of the CHFC by the Federal Ministry for Education and Research (BMBF, grants 01EO1004 and 01EO1504). The CHFC building was funded by the Free State of Bavaria, supported by federal funds according to article 91b of the Basic Constitutional Law of the Federal Republic of Germany. Conflict of interest: none declared. References References are available as supplementary material at European Heart Journal online. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

Journal

European Heart JournalOxford University Press

Published: May 21, 2018

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