Chronic aortic aneurysms are permanent and localized dilations of the aorta that remain asymptomatic for long periods of time but continue to increase in diameter before they eventually rupture. Left untreated, the patients’ prognosis is dismal, since the internal bleeding of the rupture brings about sudden death. Although successful treatment cures the disease, the risky procedures can result in paraplegia from spinal cord ischaemia or even death, particularly for aneurysms extending from the thoracic to the abdominal aorta and thus involving many segmental arteries to the spinal cord, i.e. thoracoabdominal aortic aneurysms of Crawford type II. Although various strategies have achieved a remarkable decrease in the incidence of paraplegia, it is still no less than 10 to 20%. However, it has been found that the deliberate occlusion of the segmental arteries to the paraspinous collateral network finally supplying the spinal cord does not increase rates of permanent paraplegia. A therapeutic option, ‘minimally invasive segmental artery coil embolization’ has been devised which proceeds in a ‘staged’ way to occlude groups of arteries under highly controlled conditions after which time must be allowed for arteriogenesis to build a robust collateral blood supply. PAPA-ARTiS is a phase II trial to demonstrate that a staged treatment approach can reduce paraplegia and mortality dramatically. It can be expected to have both a dramatic impact on the individual patient's quality of life if saved from a wheelchair, and also upon financial systems through savings in; 1) lower costs in EU health care; 2) lower pay-outs in disability insurance (est. at 500k in Year 1), and; 3) loss of economic output from unemployment. Approx. 2500 patients a year in Europe undergo these high risk operations with a cumulative paraplegia rate of over 15%; therefore >100M per year in costs can be avoided and significantly more considering the expected elimination of type II endoleaks.

RITMOCORE is addressing the evolution in the treatment of elderly patients with arrhythmias using or in need of a pacemaker. The proposed approach promotes a comprehensive model of care including: empowerment of general practitioners and integration of care pathways through the adequate information sharing; remote monitoring of pacemakers; home monitoring of vital signs using wearables, Apps and available innovative devices; patient activation and increases the alignment of objectives among all involved stakeholders (providers, doctors, Hospital managers, patients). To achieve these goals RITMOCORE proposes to move from a conventional purchasing of devices to an innovative service provision able to complement the resources of the public service providers including: support center for remote monitoring of pacemakers, delivering of pre-defined information sets to all stakeholders and professionals involved in the care path, integration and quality labeling of vital signs home monitoring devices and wearables and support for patient activation. The service will be based on a risk sharing model. Several partners of RITMOCORE are already working together on STOPandGO, a PPI addressing the development of a European Specification Template and a Reference Business Case for innovative ICT-enabled services for elderly people, being validated in 7 procurements. The experience of STOPandGO has been extremely enlightening on the main difficulties in addressing a PPI and the STOPandGO results will be used to shape the Business Case and the High Level Specifications in RITMOCORE. RITMOCORE procurers are leading cardiac care hospitals: Sant Pau in Barcelona (Spain), Liverpool Heart and Chest NHS Hospital (UK), Elisabeth-TweeSteden Hospital (NL) and the Regional Healthcare Trust of the Marche Region, with its hospital in Fermo (IT).