Exiting the cardiovascular disease continuum

This month, clinical studies within the EXIT-CVD research consortium will start. The five-year project, coordinated by the UMCG and Philips, received almost 28 million euros in funding. It seeks to improve cardiovascular care through interventions along the entire cardiovascular journey at three key exit points: early, mid and late exit. The project includes 22 clinical studies that will be conducted across 17 European countries. The UMCG leads six of these studies and leads a work package on equity. “We move from ‘doing research on patients’ to ‘developing solutions with patients’.”

More than 60 million people in the European Union are living with cardiovascular disease. Without early detection, timely diagnosis and appropriate treatment, cardiovascular disease can progress silently from early risk factors to established disease and ultimately, cardiac events that may lead to premature death.

“Our vision is a future where heart disease is no longer an irreversible pathway,” said Professor Pim van der Harst, project coordinator of EXIT-CVD and head of Cardiology at the UMCG. “By understanding both the biological and social drivers of cardiovascular disease, and deploying integrated innovations across diagnostics, monitoring, and care, we can empower patients and clinicians to exit the disease continuum before it’s too late.”

Three key exit points along the disease continuum

EXIT-CVD builds on decades of cardiovascular research showing that the disease develops along a continuum. Erik Lipšic, cardiologist and head of the Cardiac Catheterisation Laboratory at the UMCG, explains: “When we talk about the cardiovascular continuum, we mean that cardiovascular disease develops over time. It may start with risk factors such as high blood pressure, high cholesterol, diabetes, or smoking. Gradually, changes can occur in the blood vessels or heart, often without symptoms, until the disease becomes clinically apparent, for example through a heart attack and progressing further to heart failure.”

Most health systems are built around acute events, like cardiac events, strokes, and hospital admissions, instead of long-term risk reduction. The focus of the EXIT-CVD project is to identify and act on three moments along the disease continuum where it is still possible to change the outcome for patients. These are called ‘exit points’: preventing and detecting disease before it develops (early exit), reversing disease progression through better diagnosis and more targeted treatment (mid exit), or halting progression and stimulating recovery in advanced stages (late exit).

Six studies led by the UMCG

At the UMCG, the Department of Cardiology has a strong foundation in the field, from early detection of coronary artery disease to novel treatments for myocardial infarction and heart failure. Additionally, the UMCG is home to major population-based cohorts and biobanks, which provides unique opportunities to study cardiovascular risk, disease development, and long-term outcomes. Lipšic: “In many ways, EXIT-CVD builds on what the UMCG has been doing for many years: understanding how cardiovascular disease develops over time, identifying who is at risk and when, and translating these insights into better prevention, earlier diagnosis, and more personalised treatment.”

The UMCG coordinates the consortium but is also one of the clinical and academic partners of EXIT-CVD. Six of the twenty-two clinical studies of EXIT-CVD are led by the UMCG, mainly focussing on advanced heart imaging and patient-friendly monitoring techniques. The imaging studies will focus on photon-counting CT techniques, robotic ultrasound and guided stent procedures. For the monitoring studies, wearable blood pressure watches and self-administered ECGs will be evaluated.

Interventions co-created with patients

The study on monitoring blood pressure is conducted in women, is patient and citizen-science-led, and is co-created with patient organisation VrouwenHart. It is an example of one of the additional objectives of the EXIT-CVD project: to co-create interventions with patients. “For us, co-creation means that patients are involved in shaping the research, not simply asked to participate in a study after all the important decisions have been made,” says Lipšic. Patients are, for example, asked what they find easy to use, whether interventions fit into their lives, and what makes them trust new technology. “We move from ‘doing research on patients’ to ‘developing solutions with patients’.”

Additionally, EXIT-CVD has made equity a part of the project from the start, with a dedicated work package addressing sex, gender, ethnicity, and socio-economic gaps in cardiovascular care. In practice, this means inclusive recruitment of historically underrepresented patient groups, plain language and multilingual materials, explicit attention to bias in AI tools, and digital access handled through the citizen-science and co-design approach.

Creating better clinical practice for all patients

Ultimately, the EXIT-CVD project aims to reshape cardiovascular care in both prevention and clinical practice. “We are not only asking, ‘Does this technology work?’, but we are also asking, ‘Can doctors and nurses actually use it? Does it fit in healthcare systems? Is it affordable? Will patients use it?’”, says Lipšic. The goal is that patients notice improvement by avoiding hospital admission, getting the right treatment sooner, and improving recovery after serious heart disease. By addressing the three exit points, the consortium will help establish a new approach to cardiovascular health across Europe.