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Research led by Dr Watson has demonstrated that chronic pancreatitis (CP) is more common and clinically significant in dogs than veterinary surgeons previously recognised, with strong breed predispositions. Prior to this work, the veterinary profession believed that dogs had a single attack of acute pancreatitis which did not result in the development of exocrine pancreatic insufficiency (EPI) and/or endocrine insufficiency (diabetes mellitus (DM)). The work by Watson has shown the importance of chronic disease and has altered the long term treatment of affected dogs across the profession. It has also prompted companies in the UK, Europe and the USA to increase their focus on low-fat dietary management, pancreatic enzyme supplementation and analgesia improving the quality of life of affected dogs.
Clinical research at RVC commencing in 1994 has changed clinical practice in management of feline chronic kidney disease (CKD) by transforming international consensus on diagnostic and treatment guidelines on proteinuria, hypertension and hyperphosphataemia. The research has informed the development of new products to manage hyperphosphataemia and diagnostics for identification of low level proteinuria in cats, deemed unimportant prior to publication of the RVC's research. RVC academics have worked in partnership with industry and used research results to change clinical practice guidelines through participation in consensus expert groups and increasing acceptance of new guidelines by outreach activities to general practitioners in UK, Europe, Asia and the USA in the form of publication of textbook chapters, lectures at major conferences and e- learning platforms to explain the underpinning research-based evidence.
Randomised placebo-controlled trials (RCTs) are the most robust way to demonstrate the effectiveness of medical therapies. The University of Glasgow's Robertson Centre for Biostatistics (RCB) is internationally renowned for its biostatistical input and leading roles on landmark RCTs of cardiovascular therapies. The findings of the BEAUTIFUL and SHIFT studies underpinned European and UK regulatory approval for a novel use of the heart-rate-lowering drug ivabradine, potentially preventing thousands of hospital admissions for heart failure every year. The IONA trial supported UK approval of generic versions of another heart drug (nicorandil), thereby enhancing cost-effectiveness for the NHS. The BEAUTIFUL, SHIFT, DOT-HF and CAPRICORN trials provided the evidence base for US, European and UK guideline recommendations, steering best practice for treatment of patients with heart disease worldwide.
Sudden cardiac death causes 4.5 million deaths worldwide each year many of which could be prevented by implantable cardioverter defibrillators (ICDs), but these also carry risks. Research in the groups of Huang and Grace has led to diagnostic assays offering three times the predictive accuracy of current approaches in guiding cardiologists concerning indications for ICD implantation. The assay has been clinically trialled; since 2008, through the trial, the lives of three patients identified by the assay as at high risk were saved. Further work led by Grace and colleagues provided an improved, subcutaneous ICD (SICD); Grace also participated in a US-based clinical trial (NCT00399217) providing the evidence required for FDA approval supporting also later inclusion into NICE guidance. Since 2008 the SICD has been implanted in over 2500 patients in 16 countries.
Research led by Professor Harry Hemingway at UCL on the quality and outcomes of care of people with, or at risk of, cardiovascular diseases has informed guidelines and clinical management in a number of areas. The work influenced NICE guidelines on Chest pain of recent onset (CG95) with regard to the use of exercise electrocardiography (ECG) in the diagnosis of stable angina and approaches to sex and ethnicity in diagnosis. Our research also underpinned recommendations on revascularisation in the NICE guidelines on Management of stable angina (CH126). Additionally, the research has led to recommendations about the need to assess psychosocial factors including depression in people with myocardial infarction.
Veterinarians have long recognised health problems associated with in-breeding and extreme conformation in various pedigree dogs. However, the `Pedigree Dogs Exposed' documentary in 2008, which particularly featured the plight of Cavalier King Charles Spaniels (CKCS), and resultant independent inquiry reports, to which RVC contributed, brought the extent and severity of the issue into the public eye. RVC's ongoing programme of research linked to interaction with stakeholders has contributed to the changes in breed standards instituted by the Kennel Club (KC); understanding of underlying principles governing the relationship between structure and function and affecting desired traits; developing tools to address conformation-related health problems; and driving changes in breeding practice leading to healthier dogs.
Systemic sclerosis (SSc) is an important, but uncommon, connective tissue disease with high mortality and has a major non-lethal morbidity. Research at UCL has been instrumental in defining modern management of SSc and has contributed in three main ways. First we have defined the importance of regular proactive screening of cases, secondly we have defined the use of immunosuppression and thirdly we have delineated important clinical and laboratory subsets of SSc that underpin an individualised (or personalised) approach to assessment and treatment. These topics exemplify stepwise progress in management of SSc that also has direct relevance to other more common medical conditions.
The research described below has made a major contribution to the clinical and preclinical development of endothelin receptor antagonists (ERAs) for the treatment of systemic sclerosis (SSc). As a result, ERAs are now standard management for pulmonary arterial hypertension related to connective tissue disease and specifically complicating SSc. This work has also led to the licensing of bosentan (one of the ERAs) for digital ulcer disease, a major non-lethal complication of SSc that impacts on quality of life, employment status and the major economic cost of SSc management. By 2012, more than 16,000 patients with SSc had been treated worldwide with these therapies, with numbers increasing every year.
Over the past decade our research findings have impacted on the diagnosis and treatment of patients with inherited cardiomyopathies. Our work on risk stratification in patients with hypertrophic cardiomyopathy forms the basis for international guidelines on the use of implantable cardioverter defibrillators. Our research in patients with arrhythmogenic right ventricular cardiomyopathy has led to the development of a new international standard for the diagnosis of disease in patients and relatives. We have contributed to national and European guidelines on genetic testing in these conditions. We have also been influential in changing national policies, service design, and provision of care for inherited heart muscle disease.
Impact: Health and welfare; a clinical trial demonstrated that statin therapy is ineffective in aortic stenosis; this informed international guidelines and changed clinical practice.
Significance: Unnecessary statin therapy is avoided in up to 500,000 people in the UK alone, saving the NHS £169M p.a. Known statin side-effects of myalgia or hepatic dysfunction are avoided in 30,000 patients.
Beneficiaries: Patients with aortic stenosis; the NHS and healthcare delivery organisations, the economy.
Attribution: Newby and Boon, UoE, undertook the first investigator-led randomised controlled trial of statin therapy in aortic stenosis: the SALTIRE trial.
Reach: Aortic stenosis affects 2% of people over 65. The SALTIRE trial results informed European and N American guidelines and have impacted the treatment of millions of people globally.