Our research
In Cardiology, heart failure and valvular disease are increasing in prevalence, associated with poor quality of life and poor prognosis, and are causing a substantial burden on patients and the health care system.
Heart failure is associated with reduced or preserved ejection fraction (HFrEF and HFpEF). Neurohormonal antagonist drugs improve outcomes in patients with HFrEF, and represent one of the greatest advances in the history of medicine. However, major unmet needs remain:
- In HFrEF, implementation of existing evidence-based therapy is poor
- In HFrEF, despite effective therapy and even with optimal implementation, the disease progresses to advanced heart failure, with few treatment options
- In HFpEF, the pathophysiology remains poorly understood and there are limited treatment options.
Our research program in heart failure is broad, from bench to bedside and to society. Our group consists of multiple clinical researchers, PhD students, post-docs and fellows, statisticians and data managers, and research nurses. We also collaborate extensively with other groups at Karolinska, throughout Sweden, and globally. Valvular disease is both a cause and consequence of heart failure, but optimal timing of intervention remains uncertain.
Valvular disease is both a cause and a consequence of heart failure, and is associated with numerous complications also in the absence of heart failure. Historically, the only treatment was surgical or symptomatic, but rapid technological advancements now allow for specific, targeted, catheter-based interventions with impressive symptomatic relief and effects on outcomes. However, key questions require further study:
- What are the mechanistic drivers of valve disease
- How can valve disease be prevented, and how can interventions be better targeted to those with the most to gain.
Selected specific areas of study include:
Registry based research in heart failure and valve disease, using the Swedish Heart Failure and Valve Intervention Registries within SWEDEHEART, linked to patients registries, dispensed drug registries, and administrative population and socioeconomic registries.
The European Society of Cardiology (ESC) heart failure registries
Biomarkers, imaging, and omics data to predict new onset heart failure and valve disease, outcomes in prevalent heart failure and valve disease, and specific targets for intervention, using Swedish registries and the extensive SCAPIS cohort.
Designing and conducting pragmatic and registry based randomized controlled trials (RCTs and RRCTs), focusing on drug and intervention repurposing and new-use concepts for existing generic drugs. SPIRRIT-HFpEF is the first pragmatic trial in HFpEF, see https://www.ucr.uu.se/rikssvikt/rrct/spirrit-hfpef
Outcomes studies in large collaborative valve intervention registries
- Heart failure with mildly reduced ejection fraction (HFmrEF): characterization and testing whether HFrEF therapy may be beneficial also in HFmrEF.
- Heart failure with preserved ejection fraction (HFpEF): risk factors, comorbidity and cause specific morbidity and mortality; focus on novel mechanisms and targets, including comorbidity and adiposity-driven systemic inflammation and microvascular dysfunction; and interventional trial design.
- Heart failure with reduced ejection fraction (HFrEF) and advanced heart failure: novel mechanisms for contractility; discovering novel targets and developing novel treatments targeting contractility: inotropes, myotropes, calcium sensitizers.
- Physiologic, neurohormonal and metabolic aspect of heart failure with preserved and reduced ejection fraction, and effects of heart transplantation and mechanical circulatory support (LVAD and ECMO).
- Early phase (phase 2) human interventional trials of existing drugs for novel indications (repurposing) and of novel drugs and peptide hormones as treatment for heart failure.
- Implementation science: How to optimize utilization of existing therapy for heart failure with reduced ejection fraction and for valve disease.
- Highly qualified and motivated individuals interested in pursuing mechanistic, clinical or registry based research in the field of heart failure are welcome to contact our group.