Heart failure poses a large burden on patients and healthcare, largely because heart failure patients have low fitness and require frequent hospitalisation for close monitoring. In CardiacCare@Home, researchers work together with patients, doctors, industry, and others to develop technology for home-based monitoring of cardiac function and rehabilitation. This approach facilitates early detection of worsening of cardiac function, which allows doctors to rapidly alter treatment and prevent hospitalisation. Moreover, home-based rehabilitation will improve patients’ fitness levels. Technological innovations will facilitate a new care path that improves patients’ quality of life and lower socio-economic costs, and lower burden for hospital staff.

NANOSPRESSO-NL specifically addresses the current mismatch between personalized therapeutic strategies and industrial centralized large-scale manufacture of medicines. The NANOSPRESSO-NL consortium is convinced that nucleic acid therapeutics are uniquely qualified for production in local hospital pharmacies in response to the needs of the individual patient. By switching towards a fully standardised platform formulation, quality control can be centred around the production process rather than the end product, quite similar to a popular method of decentralized high-quality espresso making.

In the Netherlands, there is no national approach for early detection of cardiovascular disease, kidney disease and type 2 diabetes in the general population, despite the social and economic impact of these disorders. The Check@Home consortium was founded to fill this gap and is committed to set up an accessible and (cost-)effective national program for the early detection and treatment of chronic diseases to prevent progression and complications. A program that is accessible to all socio-economic groups, takes place in the citizens own living environment, reduces the burden on primary care and contributes to the affordability and sustainability of healthcare. Check@Home is an initiative of the Dutch CardioVascular Alliance, Dutch Heart Foundation, Dutch Kidney Foundation and Dutch Diabetes Research Foundation and involves citizens, patients, private parties, and experts from various disciplines (life sciences, health economics, humanities, social sciences, communication). To closely match the wishes and needs of citizens, the program will be developed and implemented with citizens, including vulnerable groups, and other stakeholders in 4 regions in the Netherlands (Breda, Utrecht, Arnhem, and Eindhoven). 160,000 people (50-75 years) will be invited for a home-based test using the Check@Home digital platform. In case of early signs of type 2 diabetes, cardiovascular or kidney damage, a targeted work-up will follow in a regional diagnostic center. If necessary, lifestyle advice and initiation of medication will be provided to relieve regular care as much as possible.

In the Netherlands, 2,300 women annually face a diagnosis of Ductal Carcinoma In Situ (DCIS) and can progress to breast cancer. However, the majority never will. As harmless and hazardous DCIS cannot be distinguished yet, all women get intensive treatment. So, many women carry the burden of overtreatment without any benefit. To reduce this overtreatment, highly innovative, integrative artificial intelligence will be developed, inspired by how weather forecasting is improving over time. This dynamic DCIS-risk forecasting will prevent needless treatment for women with harmless DCIS, preserve their quality of life, and save €15 million/year health care costs.

Prognosis of outcome of patients in coma after cardiac arrest is crucial for decision making on (continuation of) treatment. Recent research has shown that visual classification of continuous EEG enables ultra-early, high quality prognosis of poor outcome within 24 hours. This technological innovation, in particular when translated in a quantitative index, may deepen existing controversies with regard to expected quality of life of surviving patients. It may also aggravate tensions between personal values (life of relatives) and societal concerns (cost reduction). Finally, introduction of EEG-based technology enabling ultra-early prognostication may create new controversies regarding timing of the prognosis and subsequent decision making. This project aims to develop the EEG-based prognostic technology in such a way that it contributes to good prognostic practice for comatose patients after cardiac arrest, and thus can be considered a responsible innovation. It explores how EEG-enabled prognosis might affect values in care for comatose patients, comparing the Netherlands, the USA and Germany. A mixture of qualitative (ethical ethnography, interviews) and quantitative methods (stated preference survey) is used. Subsequently, the project investigates by way of stakeholder workshops and normative analysis which conditions need to be satisfied to ensure that introducing EEG-monitoring is ethically and socially desirable. The ultimate aim is to embed these conditions in the material (hard- and software) and the social components (clinical practice, regulation) of prognostic practice, using methods derived from value sensitive design. Finally, the usefulness of the insights gained for innovation of coma prognostics and responsible innovation more generally will be explored.