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.
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.
University of Bristol researchers at the Bristol Heart Institute (BHI)
have pioneered the development and clinical take-up of the novel technique
of off-pump coronary artery bypass (OPCAB) surgery. Over ten clinical
trials and several large cohort analyses have assessed the impact of this
technique on elective and high-risk patients. The results have shown that
it is as safe as the conventional coronary artery bypass grafting (CABG)
technique that uses a cardiopulmonary bypass pump and cardioplegic arrest.
Most importantly, however, OPCAB significantly reduces the risk of
post-operative complications, and reduces morbidity and mortality. It also
uses less hospital resources, reducing time in intensive care and length
of hospital stay. In 2011 (the last year for which data are available),
20% of CABG operations in the UK were carried out with the OPCAB technique
and it has had significant take-up overseas (for example, 18% of CABG
operations in the US and 21% in the EU in 2010). NICE has recommended the
safety and efficacy of OPCAB surgery.
Impact: Health and welfare; the GRACE risk score (derived using
data from 102,000 patients with acute coronary syndrome (ACS) in 30
countries) identifies high-risk ACS patients more effectively than do
Significance: GRACE is now a reference standard and has resulted
in international guideline changes. It is estimated to save 30-80 lives
for every 10,000 patients presenting with non-ST elevation ACS.
Beneficiaries: Patients with ACS; the NHS and healthcare delivery
Attribution: All work was led by Fox (UoE) with co-chair Gore
(University of Massachusetts) and was developed from Edinburgh-based
Reach: Worldwide: guidelines adopted in more than 55 countries;
>10,000 downloads of app.
Impact: Health and welfare, policy and clinical practice;
randomised trial evidence has changed the management and outcome of acute
coronary syndromes (ACS) globally.
Significance: Advanced anti-platelet and revascularisation
therapies have become standards of care worldwide. There have been large
(10-50%) reductions in the death rate from coronary heart disease across
Europe. Clopidogrel was the second best-selling drug in the USA in 2011.
Beneficiaries: Patients with ACS, clinical practitioners, NHS and
healthcare delivery organisations, policy-makers, pharmaceutical
Attribution: Building on prior studies, Fox (UoE) and colleagues
led multicentre randomised controlled trials; international trials were
co-chaired by Fox with international investigators.
Reach: Global; guideline changes in Europe and USA; applies to the
up to 5% of the population who have ACS.
Research at the University of Nottingham has defined the clinical
phenotype and management of lymphangioleiomyomatosis, a rare and often
fatal multisystem disease affecting 1 in 200,000 women worldwide. The
group has led the development and evaluation of new therapies and
diagnostic strategies which are now part of routine clinical care. The
research has underpinned the transformation of this previously under
recognised and untreatable disease into a condition recognised by
respiratory physicians, with international clinical guidelines, patient
registries, clinical trials, specific treatments and a UK specialist
Patients with evidence of heart failure following acute myocardial
infarction (AMI) have a particularly poor prognosis, with substantially
increased risk of death and subsequent cardiovascular events. The Acute
Infarct Ramipril Efficacy (AIRE) Randomised Controlled Trial (RCT) was an
international trial designed and led by the University of Leeds. AIRE
demonstrated, for the first time, that early treatment of patients with
clinical evidence of heart failure following AMI with the angiotensin
converting enzyme inhibitor (ACEI) ramipril significantly improved
survival and quality of life compared with placebo treated patients. The
strategy of early initiation of ACEI is now a cornerstone in the
management of patients suffering from AMI, leading to a global improvement
in post-AMI outcomes.
Impact: Health and welfare; public health studies in Sri Lanka and
clinical trials in a cohort of
35,000 pesticide self-poisoning patients have led to the withdrawal of
high-dose pralidoxime as a
WHO-recommended treatment and bans of three toxic pesticides in Sri Lanka.
Significance: Resultant changes in clinical practice and pesticide
regulation have saved 3000
lives in the last four years in Sri Lanka alone; in the rest of Asia many
times this as local guidelines
and practice have changed.
Beneficiaries: Patients and communities, healthcare providers,
Attribution: Studies designed and led, with international
collaborators, by Michael Eddleston,
Reach: International, particularly Asia, changes in WHO and
international guidelines on pesticide
Our research on brain/B-type naturietic peptide (BNP) has helped to
diagnose both types of heart failure (systolic and diastolic heart
failure) and to identify high-risk aortic stenosis patients for surgery.
We were first to demonstrate the value of BNP as a biomarker for left
ventricular systolic dysfunction, isolated diastolic dysfunction and for
aortic stenosis. BNP testing is now recommended in Guidelines as a
screening test for patients with suspected heart failure (Class I
recommendation) and in the current European Society of Cardiology
consensus statement for diagnosis of diastolic heart failure. The European
Society of Cardiology Guidelines have also introduced BNP testing in the
management of patients with aortic stenosis (Class IIb recommendation).
Basic molecular genetic research undertaken over the last 20 years by UCL
Cardiovascular Genetics has had a significant impact on the identification
and treatment of patients with familial hypercholesterolaemia (FH). We
have developed DNA testing methods in the three genes currently known to
cause FH and have established DNA diagnostic protocols which are now in
wide use throughout the UK. As a direct consequence of our work, we
estimate that up to 3,000 FH patients in the UK have had their diagnosis
of FH confirmed by a DNA test. Our work led to the National Institute of
Health and Clinical Excellence (NICE) in 2008 strongly recommending DNA
and cascade testing and early treatment with high intensity statins, and
furthermore, the inclusion of FH checks in the NHS's Vascular Checks