Healthcare is the fasted growing EU27 expenditure. Personalised medicine, comprising tailored approaches for prevention, diagnosis, monitoring and treatment is essential to reduce the burden of disease and improve the quality of life. Integration of multiple data types (multimodal data) into artificial intelligence models is required for the development of accurate and personalised interventions. This is particularly true for the inclusion of genomic data, which is information-rich and individual-specific, and more routinely available as the cost of sequencing continues to fall. Multimodal data integration is complex due to privacy & governance requirements, the presence of multiple standards, distinct data formats, and underlying data complexity and volume. NextGen tools will remove barriers in data integration several cardiovascular use cases. NextGen deliverables will include tooling for multimodal data integration and research portability, extension of secure federated analytics to genomic computation, more effective federated learning over distributed infrastructures, more effective and accessible tools for genomic data analysis; improved clinical efficiency of variant prioritisation; scalable genomic data curation; and improved data discoverability and data management. A comprehensive gap analysis of the existing landscape, factoring ongoing initiatives will ensure NextGen deliverables are forward-looking and complementary. NextGen embedded governance framework and robust regulatory processes will ensure secure multi-jurisdictional multiomic multimodal data access aligned with initiatives including “1+ Million Genomes” and the European Health Data Space. Several real-world pilots will demonstrate the effectiveness of NextGen tools and will be integrated in the NextGen Pathfinder network of five collaborating clinical sites as a self-contained data ecosystem and comprehensive proof of concept.

More than 50% of the newly diagnosed breast cancer patients are elderly and particularly susceptible to cardiotoxicity of cancer treatment due to age-related factors and prevalence of multiple co-morbidities. The cumulative effect of risk factors in the elderly patient resembles a “snowball effect”, where baseline age and cancer-related changes are exacerbated by direct therapy-induced cardiotoxicity, resulting to a multi-morbid state and mortality. Frailty and high risk of cardiotoxicity in this group may lead to inappropriate interventions and undertreatment, resulting in poorer outcomes, deterioration of QoL and increased healthcare costs. Considering, that older cancer patients are underrepresented in trials, new interdisciplinary and patient-oriented studies able to provide clinical guidelines and best practices for delivering quality care are needed. CARDIOCARE will contribute to scale up a better management for the multimorbid elderly breast cancer patients. Innovative eHealth applications, coupled with sensors and wearables, will permit a consistent evaluation of the intrinsic capacity and by combining clinical and biological features, will provide a holistic approach to the management of cancer and his co-morbidities in the elderly population. This will allow the development of quality indicators for effective care pathways and allow a more informed approach to breast cancer patients with multimorbidity, training and education of caregivers and stakeholders to boost effectively elderly breast cancer patients along disease trajectory and cardiotoxicity. eHealth applications will increase the involvement and participation of the patients in their care process and self-management improving adherence to their individualized care plan, and a better psychological adaptation to their disease. Overall, the implementation of a comprehensive model for effective risk stratification will positively impact on QoL, adverse events, hospitalizations, and healthcare.

Atrial fibrillation (AF) is an increasingly common arrhythmia in the aging European population. Its prevalence will more than double by the year 2050 affecting 5% of EU women and men aged ≥65 years. AF carries a high risk of stroke, heart failure, and dementia, which result in a significant loss of quality-adjusted life years and high mortality. The EU guiding principles for active aging (no. 17468/12) recommend disease prevention to maximise healthy life, and early detection of AF is recommended by the European Society of Cardiology (ESC). Nonetheless, to date, a risked-based screening strategy is lacking. AFFECT-EU’s major goal is the development of a risk-based, accurate, and ready for implementation AF screening algorithm, using digital devices, for early AF detection in the community. For this objective we will (1) Develop a risk-based AF screening algorithm, by combining the available information from the largest outcome trials (Danish LOOP, STROKESTOP, SAFER) and multiple screening studies across Europe (Ntotal>100,000) including health modifiers and biomarkers; (2) Refine the stratification of high-risk populations in a personalised approach through exploration of distinct digital screening methods and multiple health determinants in deeply-phenotyped population cohorts; (3) Validate the AFFECT-EU risked-based screening recommendations in a meta-analysis of European and world-wide studies; (4) Demonstrate cost benefits and acceptability of AF screening across different European healthcare systems; (5) Identify the AF screening potential to be taken up by differing healthcare systems; (6) Foster the dissemination of results and adoption of the risked-based AF screening algorithm in the ESC (an AFFECT-EU partner) guidelines. AFFECT-EU will develop the first targeted, risk-based AF screening algorithm, and thus contribute to the reduction of AF-related health inequities, morbidity and mortality in Europe.

The increasing life expectancy of the population and the development of effective therapies result in a growing population of aged cancer survivors, which frequently have comorbidities for developing heart failure (HF). Anthracyclines (AC) are still first line treatment for many cancer types, but up to 35% of patients who received them develop cardiotoxicity and HF. The trade-off between cancer and chronic HF is of massive psychological burden for patients, and of devastating economic consequences for healthcare systems. We aim to test the efficacy of a novel intervention (remote ischemic preconditioning) to reduce the incidence of AC-induced HF. We have selected Non-Hodgkin lymphoma as the target population, since it is diagnosed at advanced comorbid age in both genders. This will also allow us study gender differences in AC-induced HF. A phase II randomized clinical trial enrolling 608 patients undergoing AC chemotherapy will be done. Primary endpoint will be based on serial cardiac magnetic resonances exams. Taking advantage of the recruited population and data gathered, we will further validate 2 novel cardiac magnetic resonance imaging methods: a novel early marker of cardiotoxicity, and a new sequence allowing a massive reduction of acquisition time. We will also study a personalized strategy to empower patients in clinical trial execution, which includes Patient-Reported Outcome and Experience Measures (PROMs and PREMs). Our final goal is to reach the patient level by implementing the novel strategy at the clinical level while paving the way for a future large phase III trial. For this endeavour, we count on a multidisciplinary consortium, where different stakeholders of this process are part of the study, from scientists to industry, and from healthcare providers (physicians and nurses) to patients. RESILIENCE deals with 2 of the most frequent non-communicable diseases in Europe (cancer and HF), responsible for a big proportion of healthcare expenditures.