Europe is facing huge challenges due to demographic changes. The proportion of people over 65 is expected to increase to 28% by 2060; during the same period, the proportion of those over 80 will grow to 12%. The European Union and the World Health Organization (WHO) are currently working to spread awareness of the need to redefine the healthcare systems to better address new public health challenges, with particular attention to older people. The goal is to provide older people with the chance of a longer and healthier life, while maintaining functionalities

Coordination and promotion of scientific research in the field of aging in Italy and Europe, with a focus on multimorbidity, frailty, chronic diseases and long term care
Indeed, these conditions along with the progressive reduction of autonomy in daily activities determine more than others the clinical and care complexity of older people
Contribution in the standardization of the clinical definitions of multimorbidity and frailty to guide biogerontological research and the identification of relevant biomarkers

The Aging Network currently counts 13 Italian Research Hospitals (Istituti di Ricovero e Cura a Carattere Scientifico, IRCCS) that, while operating in different areas in compliance with European standards, share a common interest in Geriatrics and Gerontology.  

1. IRCCS - Istituto Nazionale di Riposo e Cura per Anziani (INRCA) 
2. Fondazione IRCCS Ca’ Granda Ospedale Maggiore 
3. Casa Sollievo della Sofferenza (CSS) – 
4. IRCCS - "Saverio de Bellis" 
5. IRCCS Fondazione Don Carlo 
6. IRCCS - Fondazione G.B. Bietti per lo Studio e la Ricerca in Oftalmologia 
7. Fondazione IRCCS - Policlinico San Matteo 
8. Fondazione Policlinico Universitario A. Gemelli IRCCS 
9. IRCCS - Istituto Auxologico Italiano 
10. IRCCS Istituti Clinici Scientifici Maugeri 
11. IRCCS - Istituto Ortopedico Rizzoli 
12. IRCCS - Istituto Ortopedico Galeazzi 
13. IRCCS - Istituto Ricerche Farmacologiche Mario Negri

Cardiovascular disease is the leading cause of death worldwide in both men and women, with an estimated 17.9 million deaths each year, corresponding to 31% of all deaths, mainly from heart attacks and strokes. Reducing mortality from cardiovascular disease requires action at several levels and prevention is a crucial strategy. Promoting policies that can have a positive impact on improving the diagnosis, treatment and prevention of cardiovascular disease would result in an improvement in the patient’s quality of life and, in the medium and long term, in a significant reduction in health costs. Today, the management of patients at high cardiovascular risk represents an integrated working model among specialists, where the exchange of information is fundamental to optimize therapeutic results and make rational and targeted use of available resources

The CARDIOLOGY NETWORK is the largest Italian research network in the cardiovascular field. The Network was promoted by the Ministry of Health and established in 2017 to foster cooperation between recognized Italian Research Hospitals (Istituti di Ricovero e Cura a Carattere Scientifico, IRCCS) working in the cardiovascular field (public and/or private), through the creation of a network of information and collaboration. The mission of the CARDIOLOGY NETWORK is to facilitate and promote scientific and technological research in the field of cardiovascular diseases and related risk factors, in order to improve diagnosis, treatment and care. The objectives that the Network aims to pursue are:

• Promoting scientific and technological research in the field of cardiovascular diseases and related risk factors
• Supporting the creation of common experimental and clinical research platforms
• Promoting the optimization of care and its harmonization
• Supporting training also through the definition of new career pathways

In order to achieve its mission in the cardiology field, the Cardiology Network carries out several activities:

• promotes and enhances scientific research in the cardiovascular field through the coordination of studies and research that can significantly contribute to the development of technology and knowledge
• fosters international cooperation with research organizations through the implementation of joint projects and intervention strategies
• identifies industrial partners interested in the implementation of research activities aimed at patient care, assistance and rehabilitation
• identifies calls for proposals and funding opportunities, public and private, for the financing of all its activities
• supports training activities aimed at fostering the dissemination of knowledge and increasing awareness and exploitation of all areas related to cardiovascular disease by collaborating with experts in different fields of interest
• encourages debate within the scientific community through the organisation of round tables, conferences, studies, events, cultural itineraries, publications, competitions and anything else necessary to promote the study of cardiovascular disease and associated risk factors
• raises the awareness of the public opinion and local, regional, national and international public bodies, with any event and any means of information, to defend their health from cardiovascular diseases and the importance of prevention

CLINICAL AND IMAGING BIOMARKERS ASSOCIATED WITH PLASMA AND CELLULAR DETERMINANTS OF CARDIOVASCULAR DISEASE AT THE TIME OF COVID-19 (2020)
Despite enormous advances in diagnosis and therapy and the associated decrease in mortality, cardiovascular (CV) disease is still the leading cause of mortality in the world today. Among the unmet needs, one of the most important is the definition of better strategies aimed at reducing the incidence of cardiovascular events of acute coronary syndromes. The current pandemic due to 2019 novel coronavirus disease (COVID-19) represents an unprecedented and severe public health problem, burdened with high rates of hospitalization and mortality, as in the case of Northern Italy. It may cause interstitial pneumonia and, in up to 15% of patients, it progresses towards severe acute respiratory syndrome (SARSCoV-2), frequently complicated by acute respiratory distress syndrome (ARDS), and important cardiovascular complications have been suggested. SARS-CoV-2 not only causes viral pneumonia but has major implications for the CV system. Patients with CV risk factors including male sex, advanced age, diabetes, hypertension and obesity, as well as patients with established CV and cerebrovascular disease, have been identified as particularly vulnerable populations with increased morbidity and mortality when suffering from COVID-19. Moreover, a considerable proportion of patients may develop cardiac injury in the context of COVID-19, which portends an increased risk of in-hospital mortality. Acute and chronic cardiovascular complications of pneumonia are common and result from various mechanisms, including relative ischaemia, systemic inflammation, and pathogen-mediated damage. There is, however, only limited published data concerning cardiovascular presentations in the wake of viral epidemics. Data collected during the COVID-19 pandemic have highlighted a number of possible determinants of adverse outcome in COVID-19 patients, in particular with reference to cardio-respiratory complications. Given the enormous burden posed by this infection and the significant adverse prognostic impact of cardiac involvement, in this research program the Cardiology Network willstudy the incidence, mechanisms, clinical presentation and outcomes of CV disease taking into consideration the effect due to the COVID 19 infection. Moreover, the concept of cardiovascular risk profile will be reassessed by the development of innovative investigations and the collection of biological samples and clinical data in subject exposed not only to traditional risk factors but also to negative environmental changes such as the dramatic occurrence of SARSCOV-2 pandemia during 2020

CARDIOVASCULAR Manifestations in Long Covid: Diagnostic Evidence, Thrombotic, Infectious, Immunological, Cellular and Tissue Inflammatory Mechanisms (2019)
Many patients 'cured' of COVID-19 show a heterogeneous constellation of symptoms and late complications (extreme fatigue, difficulty or loss of attention/memory, immunological, respiratory, cardiovascular, central and peripheral neurological, muscular, haematological, gastrointestinal, renal/urinary, endocrine and cardiometabolic disorders) without a certain identified cause. The occurrence or persistence of symptoms is independent of the severity of the acute infection, and affects both patients hospitalised in intensive care and medical wards and patients who have not required hospitalisation. The number and complexity of symptoms may instead reflect the severity of COVID-19, although the available data are not consistent. Cardiovascular involvement, together with pulmonary and neurological involvement, constitutes one of the most relevant clinical areas, including, on a subjective level, palpitations, chest pain, dyspnoea, and orthostatic postural hypotension, and on the level of possible events, episodes of decompensation, arrhythmias, and acute coronary syndromes in low-risk subjects
To date, several definitions have been generated to describe this complex clinical condition, but the WHO has assigned a code 'Long COVID', which includes both adults and children. The scale of the problem is such, that it has led to the establishment of Long-COVID outpatient clinics/reference centres, or Post-COVID Care Centres in all countries affected by the pandemic
This network project therefore proposes to develop clinical, laboratory, advanced imaging, pathological, experimental in vivo and in vitro research, with the aim of

• Derive, also in continuity with the previous 2020 network project, epidemiological, and clinical data potentially useful to characterise the spectrum of cardiovascular involvement in Long COVID in all relevant clinical and surgical settings; 
• Define, on the basis of both the results of the previous research and the new knowledge arising from this proposal, the pathophysiological basis of the symptoms and cardiovascular and thrombotic events observed in Post- and Long-COVID Syndrome or following vaccination;
• Identify objective diagnostic criteria, exploring in particular the field of biomarkers, advanced imaging; 
• Study molecular signatures, cellular and tissue mechanisms of infection and epigenetic targets of long-COVID cardiovascular pathology, to identify new markers of severity, prognosis and therapeutic targets;
• Define protocols for therapeutic and cardiovascular rehabilitation management of post- and long-COVID

The industrialised societies has experienced an increasing attention towards citiziens health. Neuro-degenerative diseases represent some of the most frequent causes of morbidity affecting the quality of life
Nervous System Diseases have the biggest economic impact on the Healthcare System, families and involved patients. For instance, dementia represents globally the highest costs for healthcare and Alzheimer Disease affects over 50 million of people all over the world. In Europe, within 2050 the annual cost for care and assistance of people affected by Alzheimer or Parkinson’s Diseases are expected to exceed 350 billion euros. Neurological diseases represent a challenge for the societies as they need to take care of the wellbeing of communities and deal with the needs for care and assistance of people affected by cerebral stroke, Alzheimer Disease, Parkinson Disease, Multiple sclerosis and their related psychological, motor and cognitive effects

The IRCCS INRCA contributes to the activities of the RIN Network providing clinical results related to clinical and instrumental screening, care and rehabilitation for neurodegenerative and vascular pathologies and their complications (malnutrition, continence disorders, dysphagia, motor and cognitive disorders), using specific and innovative pharmacological, psychosocial and technological treatments
The specific areas of interest are dementia and neurodegenerative pathologies; Parkinson’s disease and Parkinsonism; cerebrovascular pathologies; clinical neurophysiology; general neurological competencies

The Unit of Neurology, the Alzheimer’s Centre and the Stroke Unit at the IRCCS INRCA represent a regional reference point for early diagnosis and clinical definition of the different forms of dementia, thanks to the possibility of performing specific investigations: nuclear medicine, liquid biomarkers, 2nd level tests and molecular genetics.
Moreover, the laboratory of Movement Analysis and Robotic Rehabilitation at IRCCS INRCA provides personalized rehabilitation programs for each user

The Institutes participating in the RIN Network conduct preclinical and clinical research along with highly specialized care and therapeutic interventions implementing a translational continuum that put their patients at the center of care. The clinical, instrumental, molecular and neuropathological characterization of patients is the basis of pathogenesis studies aiming at identifying biomarkers for early diagnosis, therapeutic targets and innovative intervention strategies. The research results are transferred in real time to clinical practice (translational medicine)
The Network priorities, in agreement with the Ministry of Health, are focused on genomics and neuroimaging. These are fundamental tools for early diagnosis, patients’ characterization and stratification into endophenotypes, and identification of risk factors and markers of response to treatment, with the ultimate goal of implementing a precision medicine approach for each patient
Equally, the RIN Network is working on a system of specific treatments for motor and cognitive neurorehabilitation remotely delivered. The aim is to shift the focus of the healthcare system from the hospital setting to the territory, facilitating patient access to personalized services, continuity of care, quantitative monitoring of outcomes, and development of common clinical and research pathways
Structural investments of the network are financed with dedicated funds. Networks projects are based on innovation, integration and complementarity of the Institutes of the RIN Network. The scientific and clinical results of the projects are relevant for the improvement of the services provided by the National Healthcare System and the competitiveness of research activities carried out by the Institutes at national and international level

Research project 2021: Virtual National Institutes: the Italian network for neurological diseases

The project aims to start activities in the two recently established Virtual National Institutes (IVN): “Cerebrovascular Diseases” and “Rare Diseases”, working on the harmonization of clinical, imaging and laboratory protocols, as carried out in the three previous IVN: “Dementias”, “Parkinson's Disease and Movement Disorders”, and “Multiple Sclerosis and Neuroimmunological Disorders”
Moreover, during the current project, the previously established IVNs will not only complete the harmonization of activities, but also address specific scientific questions/issues of relevant clinical and care impact:

1. identification of subjects at risk for degenerative dementia in a pre-symptomatic phase, in order to define possible therapeutic targets, and to identify candidates for disease modifying treatments
2. study of genetic causes in a large sample of Parkinson's disease patients (n=1,600)
3. contribute to the overall increase of clinical and care quality - both in diagnostic/prognostic and therapeutic terms - in multiple sclerosis and neuroimmunological diseases
4. study of the pathogenesis, identification of therapeutic targets and innovative biomarkers, and development of experimental tratments