Atrial fibrillation (AF) is the commonest heart rhythm abnormality,
affecting around 8.8 million people in the European Union, and conferring
a substantial risk of stroke and death. Up to 2% of the UK population,
some 1.2 million individuals, take oral anticoagulation medication.
The University of Birmingham is an internationally-respected centre of
excellence for research in AF, and has made crucial impacts in
international clinical practice guidelines and improvements in patient
care. Primary care research at the University of Birmingham has led to the
transfer of oral anticoagulation services from secondary to primary care,
and latterly patient self-management, resulting in improved clinical
outcomes. In addition, the BAFTA trial has provided evidence to support
the use of anticoagulation therapy (warfarin) for people aged over 75 who
have atrial fibrillation, resulting in changes in clinical management of
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.
Research in Oxford by Rothwell and colleagues since 2000 has radically
changed how minor strokes and transient ischaemic attacks (TIAs) are
managed. First, the risk of a major stroke in days after a minor
stroke/TIA was found to be much higher than thought. In consequence, these
`warning' events were rebranded as a medical emergency in clinical
guidelines. Second, Rothwell showed that a delay in treating individuals
at high risk of major stroke substantially reduced the benefits. Third,
the Rothwell group developed a simple risk score (`ABCD system') to triage
high-risk individuals, showing that more urgent treatment reduced the
90-day risk of major stroke by 80%. This strategy has been implemented in
the National Stroke Strategy and NICE and international guidelines. In the
UK it is estimated to prevent 10,000 strokes per year, and to save the NHS
£200 million in acute care costs alone.
QRISK is a new algorithm which predicts an individual's risk of
cardiovascular over 10 years. It was developed using the QResearch
database and is in routine use across the NHS. It is included in national
guidelines from NICE and the Department of Health and in the GP quality
and outcomes framework. It is incorporated into > 90% of GP computer
systems as well as pharmacy and secondary care systems. The web calculator
has been used >500,000 times worldwide. ClinRisk Ltd was incorporated
in 2008 to develop software to ensure the reliable widespread
implementation of the QRISK algorithm into clinical practice.
We are facing a diabetes epidemic: the number of people affected
worldwide is estimated to rise from 366 million in 2011 to 552 million by
2030, representing a huge financial burden on society. Using data from the
United Kingdom Prospective Diabetes Study (UKPDS), the University of
Oxford's Diabetes Trials Unit developed two assessment tools - the UKPDS
Risk Engine (a diabetes-specific heart attack and stroke risk calculator)
and the UKPDS Outcomes Model (a lifetime simulator for people with
diabetes) to better understand and plan for diabetes risk and its outcomes
on both individuals and society as a whole. Patients, clinicians and
policymakers globally are now using these tools to assist in planning for
future health economic needs, and for predicting health risks for people
Stroke is the leading cause of disability and a major cause of death in
the developed world. Hypertension (high blood pressure) is the single most
important modifiable risk factor for stroke, contributing to around 50% of
all events. University of Glasgow researchers have played lead roles in
the design, conduct and analysis of pivotal clinical trials on treatment
regimens for hypertension. These research findings have informed European
and UK hypertension and stroke guidelines, advancing treatment strategies,
and contributed to the observed ~25% reduction in the incidence of primary
(first) and secondary (recurrent) stroke.
Over the past 20 years, the University of Oxford's Clinical Trial Service
Unit (CTSU), within the Nuffield Department of Population Health (NDPH),
has conducted some of the world's largest trials and collaborative
meta-analyses of trials of antiplatelet therapy, including aspirin, that
have together had a major ongoing and incremental impact on the treatment
and prevention of cardiovascular disease. They have helped ensure that
antiplatelet therapy is widely used both in the acute care of patients
with heart attacks and for the secondary prevention of heart attacks and
strokes in high-risk patients. This research has been recognised as the
gold standard for international guidelines, and has been instrumental in
changing prescribing labelling for aspirin.
Impact: Health and wellbeing; improvement in mortality and
morbidity; changes in policy and guidelines.
Significance: Clinical trial findings have led to 1160 fewer
deaths and 780 fewer severely disabled patients each year in the UK;
rationalising feeding policies saves over £12M annually.
Beneficiaries: Stroke patients, the NHS and healthcare delivery
organisations, the economy.
Attribution: Trials were designed and led by Professor M Dennis,
Reach: Worldwide: revised national guidelines in UK, Europe, North
America, South Africa, Singapore, Australasia.
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.
Approximately 25,000 people in the UK die each year from venous
thromboembolism (VTE); furthermore, VTE affects 1 in 100,000 women of
childbearing age and causes one-third of all maternal deaths.
Thrombophilia, pregnancy and the use of oral oestrogens can all place
women at increased risk of VTE when compared with other individuals.
University of Glasgow researchers quantified the probability of VTE among
at-risk women and analysed the benefits and cost-effectiveness of
thrombophilia screening. Their research is cited in the recommendations
and evidence bases of leading national and international clinical
guidelines. This work also galvanised an overhaul of VTE prevention policy
within NHS Scotland by emphasising the need for regional health boards to
implement and audit standardised in-house protocols and provide accessible
patient information on VTE.