Hull researchers conducted the key trial demonstrating that cardiac
resynchronization therapy (CRT), a specialised type of pacemaker,
significantly reduces morbidity and mortality and improves the quality of
life of selected patients with heart failure. CRT has become a cornerstone
of treatment for heart failure and a standard recommendation in clinical
guidelines world-wide. Over a 5 year period about 40,000 people in the UK
have had pacemakers implanted; about 8,000 of these patients would be
projected to have died within 5 years if they had not received CRT. The
world market for CRT devices is projected to grow to $2.8 billion annually
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.
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.
A decade of research at the University of Southampton has given thousands
of people around the world suffering from dizziness and balance disorders
access to a self-management resource that can alleviate their symptoms.
Professor Lucy Yardley has pioneered the use of a Balance Retraining (BR)
booklet to transform the means of delivering cost-effective, life-changing
treatment previously offered to less than one in ten UK patients. The
booklet, translated into several languages, has been distributed to
patients and practitioners as far afield as China and Japan. Yardley's
findings have contributed the bulk of good quality evidence to the
Cochrane Review on vestibular rehabilitation.
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.
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
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
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
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.
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.
Caulfield co-led and was a principal investigator (PI) on Anglo-Scandinavian
Cardiac Outcomes Trial (ASCOT). Hitman co-led and was a PI on Collaborative
AtoRvastatin Diabetes Study (CARDS). These studies dramatically
changed national and international guidance for diabetes, hypertension and
cholesterol, leading to widespread and far-reaching changes in management
of common and potentially fatal risk factors. For example, the proportion
of hypertensive patients in England with good BP control (<140/90) rose
from 52% in 2006 to 62% in 2011; the mean total cholesterol level of the
population has fallen by 0.5 Mmol/L between 1998 and 2011.
Impact: By showing the benefits of accurate identification and
targeted treatment of chronic fatigue syndrome, UoE research has
influenced worldwide medical practice and stimulated public and
Significance: Guidelines and policy debate have resulted in
improved patient treatment, with associated economic benefit.
Beneficiaries: Patients with medically unexplained symptoms,
Attribution: Work conducted at UoE in a team led by Carson and
Reach: The research affects the more than 25% of all GP
presentations who have unexplained symptoms / chronic fatigue syndrome
(40% in gastroenterology and neurology). Guidelines have been changed
internationally including UK, USA, Australasia.