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Capewell's MRC/EU/NIHR funded IMPACT programme has been developed at the University of Liverpool (UoL) since 1999. It examines why cardiovascular disease (CVD) death rates have recently halved in the UK, USA and Europe (mainly risk factor improvements plus modern treatments), and why CVD rates are increasing in China and most developing countries (adverse risk factor trends reflecting a Westernised diet). Results have informed CVD prevention strategies in the UK and beyond, notably NICE Guidance on CVD prevention in whole populations. The strong NICE recommendations on diet and tobacco were recently endorsed in NICE Commissioning Guidance and European and American guidance.
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.
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.
In response to the gap between standards and the reality of preventive cardiovascular disease (CVD) health care delivered across Europe, Imperial College researchers developed an innovative nurse-led, multidisciplinary, family centred, CVD prevention programme (EUROACTION) and led its evaluation in hospital and general practice across 8 European countries. We showed that patients and their families in our programme can achieve healthier lifestyles and better risk factor management compared to usual care and these differences were sustained out to one year. We then adapted our learning from EUROACTION for the NHS, by integrating secondary and primary prevention into one community service (MYACTION), and managing cardiovascular disease as a family of diseases with common antecedents. To train doctors, nurses and allied professionals to deliver MYACTION we created an MSc in Preventive Cardiology which is now in its 6th year. EUROACTION is now recommended as an evidence based model of care in current European CVD prevention guidelines, and MYACTION is being commissioned by the NHS in London, and Galway, Republic of Ireland, and by the Western Isles Health Board. Our research has impacted directly on the development and delivery of high quality preventive care in both Europe, and the NHS, and on the training of doctors, nurses and allied health professionals in preventive cardiology.
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.
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 companies.
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.
Studies coordinated by the University of Oxford's Clinical Trial Service Unit (CTSU) within the Nuffield Department of Population Health (NDPH) have strongly influenced the labelling of statin medication internationally, treatment guidelines, and the resulting changes in prescribing have contributed to reductions in mortality and morbidity from heart attack and ischaemic stroke in many countries. CTSU's randomised trials and meta-analyses of trials have shown that lowering low-density lipoprotein (LDL) cholesterol safely reduces the risk of heart attacks, strokes and revascularisation procedures in a wide range of people, and work conducted in collaboration with the NDPH's Health Economic Research Centre has provided clear evidence of cost-effectiveness of statins.
Our research has used epidemiological insights, data and methods to enable Legal & General (L&G), a major pensions and annuity provider, to understand the drivers of long-term trends in the annual rates of improvement in mortality in older ages. Our first-ever analysis of inequalities in mortality trends by cause of death over 25 years in England, and future projections of these, has resulted in better informed pricing and risk management (capital reserving) practices at L&G. We also modelled how much of the decline in coronary heart disease, the main contributor to improving life expectancy, was due to improved healthcare versus healthier lifestyles. Projections of these, based on plausible scenarios of evolution of risk factors and disease management, helped strengthen the evidence base for L&G's assumptions of mortality improvements for the UK financial regulators.
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.
Events in the UK NHS have shown the need for a robust understanding of hospital mortality rates.
Surrey's research produced "a unique web-enabled pattern analysis system that is specifically designed to enable clinicians and their teams to view in detail their in-house mortality patterns in the national context" (a).
Launched on a national scale in Ireland in 2013, it has already identified `mortality outliers' and been described as a `game changer' for improving service quality at national level. The tool's impact stems from its ability to translate statistical patterns into a form readily usable by health professionals to improve care quality and sharing best practice.