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"Research has to be interdisciplinary"

German Center for Heart Failure: "Research has to be interdisciplinary"


Photo: Georg Ertl

Georg Ertl;
© German Center for Heart Failure

The number of heart failure disease has increased for years. Drugs and a change in lifestyle can help the affected person, but a cure is still not in sight. That’s why it is all the more important to research the origins of heart disease as well as develop suitable strategies for prevention. These are some of the objectives the German Center for Heart Failure has committed itself to.

Professor Georg Ertl is the spokesperson for the German Center for Heart Failure (DZHI). He talked to about the importance of clinical research and why interdisciplinary work has such a high level of importance. Professor Ertl, you are the spokesperson for the German Center for Heart Failure in Würzburg, one of eight integrated research and treatment centers in Germany. What is heart failure?

Georg Ertl: Heart failure is not a disease. We call this a clinical syndrome, meaning a set of symptoms that can be evoked by different diseases. The most common disease that leads to heart failure is coronary heart disease, that being the affection of the coronary blood vessels with myocardial infarction or repeat myocardial infarctions.

The second most common disease is hypertension. Alongside these there are still countless other causes, but the result is similar in a certain way: The patients experience shortness of breath and dropsy, that is to say, water remains in the body and they are unable to accomplish as much as before. Heart failure attacks the entire body, meaning all organs are being seriously affected, for example the brain, liver or kidneys. How does this manifest itself?

Ertl: There are two ways. One is that all organs are being poorly supplied with blood if the heart works poorly. The second way is the body fighting against cardiac insufficiency and dumping hormones that are meant to support blood pressure. These hormones in turn affect all organs so that you may say that heart failure is an overall disease. This is very important for treatment, because you have to take into account that it’s not just the heart that is diseased, but the entire body. Why is there a special Center for Heart Failure?

Ertl: For one because heart failure is an increasing problem among cardiovascular diseases. It is age-related, that is to say the older our society is getting the more patients will get to live with heart failure. You could call it the epidemic of our century.

The second part is that most heart centers are run by cardiologists and heart surgeons. Yet the research of heart failure also requires nephrologists, endocrinologists, neurologists, psychiatrists and surgeons. This research has to be interdisciplinary and such a center is particularly suited for this.

Photo: A patient is examined

More and more people are suffering from heart failure, but older patients are especially affected; © / Yuri Arcurs What are the key aspects and objectives of the German Center for Heart Failure (DZHI)?

Ertl: The top priority of course is that in the end we are able to better diagnose and treat patients with heart failure.

The second goal is for this Center to establish research structures that are not yet available as such in Germany. That is to say, it establishes an interdisciplinary study unit. At this point, a clinical epidemiologist is very closely involved and diagnosticians from nuclear medicine and radiology are being consulted to expedite clinical diagnostics research. The keywords here are: Clinical research structural development.

The third goal that’s especially important to us is attracting young researchers. We have developed new career models. Clinical research suffers from the fact that young physicians are overburdened by routine and don’t see any real perspectives for their career. That’s why in the past they would leave for other hospitals and thus got lost as researchers. Today we have to make sure to establish career paths for physicians who want to stay in research for the long term. This is a big concern. This is why we setup study courses that are meant to inspire people during their medical studies for clinical research. What do these new career models look like?

Ertl: We thought about already admitting students who are interested in research within the context of their medical dissertation in a kind of graduate school. Here they are closely being mentored and can achieve a Masters in Clinical Research during their medical studies. This is the access to also getting a PhD afterward in addition to their MD degree, which will further distinguish them in clinical research.

After this, junior groups are available for the clinical researchers. Currently we are choosing young researchers for this. It should be at least up to five junior groups, which in turn are managed by further advanced young researchers.

The next step is a research professorship. We are currently setting up a junior professorship. For example, this one would be very interesting for dentists who are going to research connections between poor dental status and bad gums and heart diseases. Here you can also see how interdisciplinary in nature this subject is. But this is all still in its development, since the Institute has only been established for half a year. We now have appointed a clinical epidemiologist, who I hope will be able to start with the winter semester. Then we would be able to start up the Master‘s program for the summer term next year. What other countries are you modeling yourself after in your work, your research and your goals?

Ertl: For these study courses and this training for clinical epidemiology and biometry you have to for example model yourself after the Netherlands as well as individual universities in the U.S.A. As far as research is concerned of course you have to compete internationally. What other specialty areas are you collaborating with?

Ertl: We have programs with psychiatrists, psychologists, neurologists and of course heart surgeons. Then we also have a program with bariatric surgery and general surgeons, since obesity is also an enormous burden on the heart. We have endocrinologists, pneumologists, nephrologists and hemato-oncologists from internal medicine. From fundamental research we have a chemist on board, who is in charge of research and producing contrast mediums. Alongside we have physicists, who are supposed to expedite MR technology for the clinical diagnostics of heart failure. One of the objectives of the DZHI is to develop preventive strategies. Have you been able to develop and test something?

Ertl: We have been around for just half a year and you need to have staying power for clinical research. Of course our research has started long beforehand. In the past we already had the special research field for heart failure. From this the Center for Hearth Failure developed.

We have done some very intense research on how cardiac insufficiency originates and for instance analyzed mechanisms after a cardiac infarction and also decisively contributed in using drugs to prevent cardiac insufficiency from developing after a cardiac infarction. From this point on we can show results.

Another point that is very important is: Everybody in society talks about cardiac infarction or about cancer, but very little is known in the general public about heart failure, which actually is a much more prevalent and serious problem and just as severely puts a strain on the quality of life as well as also the life expectancy of patients. We see a duty in raising awareness for this. What would be one research project you would like to tackle in the near future?

Ertl: Why patient A develops heart failure with a specific disease and why patient B does not. This could be a genetic predisposition, but this could also have other causes. To break down these mechanisms is an important point where we can also continue full speed in expediting ongoing research. However, the Center is devoted to the prevention of heart failure and its complications. That is to say, we also want to prevent for patients for instance to incur renal failure and examine why some patients have renal failure and others don’t.

The interview was conducted by Simone Nefiodow and translated by Elena O’Meara.


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