Physiology of circulation, kidney and lung
Blegdamsvej 3, 2200 København N.
My research is essentially translational. In my early research, I have studied aspects of the role of sub-inflammation in vascular and metabolic insulin resistance based on experimental human studies. I subsequently established a new model in vitro in the department of Biomedicine, in Copenhagen (UCPH), to study mechanisms that may explain the effect of a high-glucose environment for a defective vascular function.
Since sub-inflammation is a risk for increased formation of blood clots, vascular and heart muscle stiffness on patients with insulin resistance, I initiated mechanistic studies associated to a randomized clinical trial, LAACS (Left Atrial Appendage Closure by Surgery). In LAACS patients were randomized to closure of the left atrial appendage or it remained open, in addition to planned heart surgery, aiming to elucidate whether this can protect these patients from future brain damage. After encouraging results with a modest number of patients (N 205) a subsequent multicenter international study (LAACS-2) is dimensioned (N 1500 patients) elucidates whether such procedure protects the patients from stroke.
The REAFEL (Reaching the Frail Elderly) project arouse inspired on the LAACS patients who found cumbersome to attend the hospital ambulatory repeatedly for follow-up on to assess atrial fibrillation occurrence. In REAFEL, patients can be evaluated at home through a novel collaborative model, “cardio-relay”, where the hospital-based cardiologist supports the Family doctor using telemedicine to engage the patient and car-givers for evaluation and treatment of heart disease. The focus condition in REAFEL is atrial fibrillation, supported by a Grand Solutions grant from Innovation Foundations.
When I presented the cardio-relay model in an international seminar, doctors from Brazil found it particularly suitable for patients in the slum areas in Rio de Janeiro. Danida supports BRAHIT, Brazilian Heart Insufficiency with Telemedicine, developed as a Danish-Brazilian collaboration.
LAACS-2. Left atrial appendage closure by surgery-2. A multicenter international study where patients undergoing heart surgery are randomized to closure of the left atrial appendage, or leaving it open in the control group. Currently active sites are Rigshospitalet (Copenhagen, Denmark), Århus University Hospital (Skejby, Denmark), Sahlgrenska University Hospital (Gothemburg, Sweden) and Vall d’Hebron University Hospital (Barcelona, Spain). The study was initiated in March 2019 and is scheduled until end of 2023.
SECAFIB. Secondary Atrial Fibrillation to temporary conditions. To identify atriopathy, 300 consecutive patients have undergone continuous heart rhythm monitoring and electrocardiogram (AI algorithms based on conventional ECG and wavECG, Myovista). The upcoming cohorts include frail elderly patients admitted with bone fractures.
Mechanistic studies are based on data and material collected in the LAACS-2 and the SECAFIB studies. Algorithms to predict patients at risk for atrial fibrillation are based on selected patients from these cohorts and re-tested prospectively in REAFEL.
REAFEL. Reaching the Frail Elderly. Mixed methods are used to evaluate the impact of the cardio-relay model to reach frail populations. These include initial ethnographic observations, followed by a feasibility study where the cardio-relay model is tested in selected Primary Care Clinic. Patients provide their perspective through questionnaires and semi-structured interviews. Experiences from the pilot study are evaluated by the participant clinics in workshops and focus-group interviews. Equivalent methods are applied to a cluster-randomization study where Primary Clinics using the cardio-relay model are compared with Primary Clinics who refer patients to the cardiologists conventionally.
BRAHIT. Mixed methods as described in REAFEL are used in Primary care clinics. Further information on the study is described in www.bmi.ku.dk/english/brahit
REACHFIT. Reaching Frail Patients to stay Fit with Telemedicine. Is a study equivalent to BRAHIT in Danish settings.
Undervisnings- og vejledningsområder
Lung and Heart Physiology for 4th. Semester Medicine Students. I undertake group- teaching (SAU24) and I am the responsible and coordinator of exercises on electrocardiography and echocardiography (SAU12).