“Networking is in the blood at CardioTech”

“One CardioTech project that I’m particularly passionate about myself involves paediatric cardiology, in which we’re collaborating with several Dutch paediatric cardiology centres,” explains professor Maaike Kleinsmann, coordinator of the CardioTech pillar within the Delft Health Initiative. “Here we’re exploring whether we can use smart monitoring to enable children with congenital heart defects to be as active as other children. This partly involves encouraging the children to take more exercise. But it’s also important to teach those around them, parents and teachers, how to handle heart disease, since the children are often held back unnecessarily by those around them, because people are scared of something happening. As a result, the children often have to play in goal in football, for example, because nobody dares to allow them to be too physically active. This is very concerning, because these children die not because of the heart defect, but more from the consequences of living unhealthily.”

“One of the things we believe very strongly is that these children must be able to exercise and play sport in their natural environment and not in a rehabilitation centre. We aim to encourage this using gamification techniques. We’re currently designing a system that gives the parents real-time information via a smart watch worn by the children. The parents can use this information to see if their child is okay. At a later stage, we intend to use the information also as input for doctors, for example in order to determine more effectively, in consultation with the parents, when the most suitable time for an operation might be. For this, we need the support of other technical disciplines, to help us to develop reliable algorithms that will be able to analyse this data.”

Prevention

Kleinsmann sees this as a good example of what CardioTech aims to achieve. "We plan to use smart technology in an effort to reduce the consequences of cardiovascular diseases. And we focus on the whole life course, from prevention through to diagnosis and treatment."

“I see the greatest potential gain in primary prevention, because you may still be able to prevent someone having a stroke or heart attack. The programme on the early detection of cardiac arrhythmia currently running in the Medical Delta Cardiac Arrhythmia Lab is an example of that. However, with research into primary prevention, the problem is that you’re often straying beyond conventional practice in healthcare. For complex reasons, projects like this are difficult to get funding for because it’s not easy to demonstrate the health benefit in a clinical study.”

“With primary prevention, you are focusing on the human side of the technology, where it is often difficult to quantify how much you will save or how much quality of life you will gain. This is why an evidence-based approach needs to be one of CardioTech's key pillars. We need to get better at demonstrating that our technological solutions actually work.”

Data

“We consider data to be the unifying element in our approach. You try to monitor someone across the course of their whole life and collect data about that life; we call this building a digital twin. It can then be used in treatment and in healthy lifestyle coaching.”

Another pillar within the CardioTech research involves moving as much research as possible from the hospital setting to monitoring at home. “That’s essential, especially in the case of cardiac arrhythmia. Of course, monitoring already exists using a so-called Holter system, but it only works for 24-48 hours. This is why we aim to improve home monitoring, partly in collaboration with Leiden University Medical Center, to see if we can continue to monitor patients after operations; we want people to rehabilitate as much as possible at home, but still be able to spot when something goes wrong. For that to happen, both patients and clinicians need to have a good idea of how they should deal with the monitoring equipment and data generated.”

Hard and soft

This is an example of where the ‘hard’, more technical, and ‘soft’, human sides of medical science need to be effectively combined. “If you ask me what motivates me, that may be the most important thing,” says Kleinsmann. “My work has always focused on the boundaries where technology has to be implemented in practice. Of course, there will always be challenges, but I detect a real willingness from everyone to cooperate in order to ensure that it turns out well. The power of technology is well understood in the medical world. And what’s great about the people in the Delft Health Initiative, and therefore also at CardioTech, is that they really grasp the area of application.”

“In the interplay between people and technology, you’re focusing very much on the prevention side and people at home. When you start to look more towards diagnosis and treatment, that’s where the hard technology comes in.”

“Yes, our work involves some hard-core technology, but it always has a use: it’s not technology just for the sake of it. Sometimes, our technology is still at quite a remove from the clinic, but sometimes it’s very close, and that's what makes it so great.”

Networks

“I graduated in Industrial Design Engineering, specialising in a cardiac monitor, so I’ve always had a medical interest. My PhD focused on a completely different subject: how people collaborate in developing products. After that, I gradually moved towards research into innovation networks. Eventually, I came across a really wonderful innovation network: a collaborative project involving the Netherlands Heart Foundation, Philips and TU Delft (CardioLab). This enabled me to perfectly combine my two research hobbies: how can we study innovation networks and learn from them and, on the other hand, the question of how we can create products and services in the medical world that are actually of value to people. And how we can do that in a systematic way so that they’re not always just random successes.”

“As part of CardioTech, I’m still very much involved with networks. At the event to mark the tenth anniversary of the Delft Health Initiative, I invited a large network of people who could prove important for CardioTech. At the time, we were actually just filling out the life course and having people explain where they are in it and what their research interests are. Even more important was the question: where do you go to find each other? The result of this was an amazing map that proved invaluable in finding consortia of people who would work together on a topic.”

Rising Stars

This approach has already resulted in three concrete projects, being led and further developed by what we call Rising Stars. “One demand we make of them is that they actually build a consortium. I don’t want them to be working alone. Networking, doing things together, really is in the blood and philosophy of CardioTech.”

The first of the three projects includes a new radar technology that can detect if people are still okay. “Many people suffer heart failure when they’re at home alone. This is where a need for care and technology come together. In this project, we’re starting with the technology, but the ‘human’ aspect will definitely be involved later.”

The second project is about a new sensor technology: we’re investigating whether we can detect a brain haemorrhage at an early stage. The third project is exploring a method to enable cheap but good quality imaging.

Pioneering

These are three early examples of what CardioTech is working on. “Moving forward, we will be working even more inclusively, ensuring everyone really can make a contribution. We’ll be running an open call for research proposals.”

“In order to reach everyone, the process of convergence between TU Delft and Erasmus University will be important. I also think that Medical Delta (the alliance involving TU Delft and the academic hospitals in Leiden and Rotterdam) is very powerful in this. The way in which we manage to find each other is quite unique.”

“With CardioTech, we can achieve a genuine life-course approach, from prevention through to treatment. With our broad expertise, we can develop research projects across the whole life course. We’re pioneering that philosophy.”