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Landmark advances in outcomes for patients with heart failure

Summary of the impact

Approximately 26 million people live with heart failure worldwide. University of Glasgow researchers have been instrumental in proving the value, in landmark clinical trials, of bisoprolol, candesartan and eplerenone — three of the four classes of drug that reduce mortality, reduce hospitalisation rates and improve quality of life for patients with heart failure. These trials led directly to revision of clinical guidelines on heart failure management globally (including in Europe, USA, UK, Australia and Canada, all published since 2008). The Glasgow researchers have established heart failure as a healthcare priority and encouraged the introduction of specialist heart failure nurses, saving the NHS an estimated £8 million per year. Collectively, these advances have transformed the treatment and survival rates of heart failure patients worldwide.

Submitting Institution

University of Glasgow

Unit of Assessment

Clinical Medicine

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Cardiorespiratory Medicine and Haematology, Clinical Sciences

Reducing mortality following acute myocardial infarction (AMI)

Summary of the impact

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.

Submitting Institution

University of Leeds

Unit of Assessment

Public Health, Health Services and Primary Care

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Cardiorespiratory Medicine and Haematology, Clinical Sciences

BNP as a Diagnostic and Risk Stratifying Test in Cardiology

Summary of the impact

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).

Submitting Institution

University of Dundee

Unit of Assessment

Clinical Medicine

Summary Impact Type

Technological

Research Subject Area(s)

Medical and Health Sciences: Cardiorespiratory Medicine and Haematology, Clinical Sciences

Transforming the treatment of atrial fibrillation

Summary of the impact

Atrial fibrillation (AF) is the most common chronic heart rhythm disorder, afflicting 1-2% of the total population and up to 10% of individuals aged over 70 years. There is an urgent need for safer and more effective therapies to prevent and treat AF. University of Glasgow researchers have played leading roles in studies that have identified strategies which prevent AF, improved the safety of AF therapies, and proved the clinical efficacy of a novel anticoagulant to reduce the risk of stroke (the major consequence of AF). The findings have rapidly informed recommendations in international guidelines, prompted regulatory amendments of AF therapies and changed prescribing practices. These advances will affect the estimated 12 million Europeans and Americans suffering from AF.

Submitting Institution

University of Glasgow

Unit of Assessment

Clinical Medicine

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Cardiorespiratory Medicine and Haematology, Clinical Sciences

Case Study 1. The Acute Infarct Ramipril Efficacy Study: a simple treatment to improve survival after acute myocardial infarction

Summary of the impact

The Acute Infarct Ramipril Efficacy (AIRE) multicentre international trial, conceived, designed, led and coordinated by Leeds was the first to show that use of early angiotensin converting enzyme Inhibitor (ACEI) therapy in patients with signs and symptoms of heart failure after an acute myocardial infarction (AMI) is associated with significantly longer survival and better quality of life. Further Leeds research showed the beneficial effects persisted long-term. The strategy of early initiation of ACEI is now a fundamental and routine part of the management of patients after AMI and has contributed to better survival and quality of life for patients around the world.

Submitting Institution

University of Leeds

Unit of Assessment

Clinical Medicine

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Cardiorespiratory Medicine and Haematology, Clinical Sciences, Public Health and Health Services

Spironolactone as a Treatment to extend life in Heart Failure Patients

Summary of the impact

Our research with spironolactone has advanced treatment in heart failure. We conducted the first "proof of concept" study to show that spironolactone had beneficial cardiac effects in man. In patients with heart failure, we demonstrated that it reduced cardiac sympathetic activity and arrhythmias. Spironolactone was pioneered in Dundee as a treatment to reduce deaths in chronic heart failure. This treatment is now recommended (Level A evidence; Class I recommendation) for the treatment of symptomatic heart failure in all guidelines including the 2010 NICE guidelines. It is also now a standard in the 2010 NHS Quality Improvement Scotland standards.

Submitting Institution

University of Dundee

Unit of Assessment

Clinical Medicine

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Cardiorespiratory Medicine and Haematology, Clinical Sciences, Medical Physiology

Development of Beta Blockers for the Treatment of Heart Failure

Summary of the impact

Beta-blockers are now a worldwide mainstay of heart failure treatment recommended in all international guidelines for chronic heart failure: this is a reversal of previous practice since they were completely contraindicated in this condition up to the late 1990s. Imperial College researchers were pivotal in defining beta-adrenoceptor/beta-blocker mechanisms in failing human hearts and translating the benefits into clinical practice. Imperial College researchers designed and led the COMET and SENIORS beta-blocker trials for heart failure and the UK arm of the COPERNICUS trial. These studies helped establish beta blockers in modern heart failure management: these are now the 4th most commonly prescribed drugs worldwide.

Submitting Institution

Imperial College London

Unit of Assessment

Clinical Medicine

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Cardiorespiratory Medicine and Haematology, Clinical Sciences, Pharmacology and Pharmaceutical Sciences

Cardiac power output as a novel approach to functional measurement in cardiovascular health

Summary of the impact

The research team at Bucks New University has provided the groundwork for a number of applications to use cardiac power output as a novel functional measurement in the clinical evaluation of patients with heart failure and other related diseases. It involved validating the measure, assessing its reliability and applying it to a group of patients with end-stage heart failure. The success of this procedure is now evidenced by the number of national and international clinical centres adopting cardiac power output as a key functional measurement.

Submitting Institution

Buckinghamshire New University

Unit of Assessment

Allied Health Professions, Dentistry, Nursing and Pharmacy

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Cardiorespiratory Medicine and Haematology, Clinical Sciences

Telehealth: From Research to Mainstream Practice

Summary of the impact

Academics from the University of Hull led a programme of research that demonstrated for the first time that telehealth (the use of technology to support remotely the delivery of healthcare) could improve clinical outcomes for patients with heart failure.

The University's Centre for Telehealth is now recognised internationally as a leader in this area, has been identified as an exemplar of best practice, and is highly influential in developing national and European guidelines. The Centre's activities have supported the development of telehealth services for thousands of patients within the UK and Europe. It is also a key player in initiatives devoted to the enhancement of telehealth services through supporting industry and training of the health and social care workforces.

Submitting Institution

University of Hull

Unit of Assessment

Allied Health Professions, Dentistry, Nursing and Pharmacy

Summary Impact Type

Societal

Research Subject Area(s)

Medical and Health Sciences: Cardiorespiratory Medicine and Haematology, Nursing, Public Health and Health Services

Heart attacks: improving therapeutic options for patients through the development of life-saving medical techniques and devices

Summary of the impact

Every year in the UK, 150,000 heart attacks are caused by coronary artery occlusion (blockage); worldwide, the figure is 17 million, according to the World Health Organization (WHO). Since 1993, the Leicester Interventional Cardiology group has been at the forefront of research to determine how best to manage such patients. Its findings have been incorporated into official UK (2008), European (2008, 2012) and US (2008) guidelines and have helped to change the way coronary heart disease and heart attacks are treated, with the number of patients treated with primary angioplasty doubling between 2008 and 2011. By guiding service provision, supporting industrial innovation and informing clinical practice, the Unit has contributed to improved healthcare and outcomes for thousands of heart patients. Overall, one-month mortality according to European figures has fallen from 15% to 4% between 2008 and 2013.

Submitting Institution

University of Leicester

Unit of Assessment

Clinical Medicine

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Cardiorespiratory Medicine and Haematology, Clinical Sciences, Neurosciences

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