Research in detail
The Heart Failure and Arrhythmia Section covers a range of areas through its research that include sleep disordered breathing, patient perspective studies, plus new and remote technologies. Today's research builds on the work that has preceded it in the past decades to build a thorough understanding of these conditions.
Sleep Disordered Breathing
Apnoea Scan Study - Linking technology with sleep disordered breathing
There are algorithms available on certain pacemakers and defibrillators, designed to detect sleep disordered breathing in patients with heart failure. We have a study in collaboration with Boston Scientific comparing the results of this with a standard sleep study. This study involves collaboration with: Dr Ali Vazir, Professor Mike Polkey and Dr Rakesh Sharma.
SERVE-HF clinical trial
Sleep disordered breathing is common in patients with heart failure with reduced ejection fraction. We have worked in collaboration with Professor Anita Simonds at the sleep and ventilation unit at the Royal Brompton Hospital to research treatment options. Professor Martin Cowie was the co-principal investigator for SERVE-HF a multinational trial with 91 centres over 11 countries. This clinical trial provided surprising results and has shown that adaptive servo-ventilation treatment of sleep disordered breathing can increase cardiovascular mortality chiefly due to sudden cardiac death.
The CardioMEMS™ device is a miniature wireless sensor that measures the pressure of blood in the pulmonary artery, the main blood vessel that carries blood from the heart to the lungs. The device is able to transmit information while patients are in their own home and the transmissions are monitored by the heart failure team who will be alerted to high readings.
Patients with heart failure are often admitted to hospital because of sudden worsening in their symptoms. Using the device to measure pressure of blood in the pulmonary artery heart failure medications can be adjusted in order to try to prevent heart failure symptoms from getting worse and requiring admission to hospital.
The Royal Brompton Hospital is the only UK hospital to implant this device. As part of this we are also collecting data on healthcare utilisation and patients’ quality of life.
- Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial, William T Abraham, Philip B Adamson, Robert C Bourge, Mark F Aaron, Maria Rosa Costanzo, Lynne W Stevenson, Warren Strickland, Suresh Neelagaru, Nirav Raval, Steven Krueger, Stanislav Weiner, David Shavelle, Bradley Jeffries, Jay S Yadav, for the CHAMPION Trial Study Group*, 2011, The Lancet, Volume 377, No. 9766, p658–666.
The BioControl CardioFit system is a new electrical stimulator system. The CardioFit system consists of three parts: a stimulator (a device similar to a pacemaker), and two leads (flexible wires) which are placed inside the body and a safety magnet. The first lead is the sensor lead which will detect your heart rate to determine the level of stimulation (electrical pulse) the device delivers to the vagus nerve. This lead is similar to a pacemaker lead. The second lead is a stimulation lead that delivers electrical pulses from the device to the large vagus nerve in your neck. This study has been stopped as early results suggested no benefits.
The group is currently taking part in an exciting collaboration between The British Heart Foundation, St Jude Medical, Boston Scientific and Medtronic looking at remote monitoring of patients implantable devices (biventricular devices and internal defibrillators) called REM-HF. It works by each device having its own communicator box which sits in the patient's home and receives data from the device. This data is sent to a secure web site where it can be accessed by the physician. This allows the physician to monitor and act on parameters such as impendence, activity, arrhythmia and heart rate.
As part of REM-HF, a sub-study called REM-AF is also being carried out which will identify the incidence of undiagnosed paroxysmal atrial fibrillation in remotely monitored heart failure patients
HOME-HF (completed study)
HOME-HF was a multi-centre randomized controlled trial of 182 patients involving three acute hospitals in urban, multi-ethnic North West London. Patients were randomised 1:1 to receive either usual care or telemonitoring. The primary outcome was days alive and days spent out of hospital. Secondary outcomes were number and duration of heart failure hospitalizations, clinic visits, and quality of life. The study found no difference in the primary outcome between groups, but there were significantly fewer unplanned hospitalizations for heart failure decompensation, and a reduction in clinic and emergency room visits in the telemonitoring group. There was no statistically significant difference in the mean direct health service costs.
TeleCraft (completed study)
The TeleCRAFT study aims were to:
- Implement a telemonitoring programme in heart failure and COPD/chronic respiratory patients by assessing the real world impact of on readmissions, consults, home visits, quality of life and economic endpoints.
- Explore the effects of telemonitoring across heart and respiratory groups with respect to i) factors that influence how patients integrate telemonitoring into their daily routines and self care behaviour and ii) how healthcare professionals use telemonitoring to aid decision- making.
- Understand the impact of telemonitoring on a variety of care pathways.
The TeleCRAFT study was a crossover implementation study with patients allocated randomly 1:1 to telemonitoring or delayed entry to telemonitoring (after 6 months). Comparisons were carried out between patients with delayed entry (controls) and active telemonitoring. In the group receiving telemonitoring in the first 6 month period we were able to assess impact of withdrawal in the subsequent 6 months.
Patient Perspective studies
We are very interested in patients' experience of healthcare and their health beliefs collected by both qualitative and quantitative methods.
The NHS culture is shifting and is now endeavouring to provide individualised care to patients. To deliver this healthcare professionals require a deeper understanding of patients beliefs and behaviours and how these impact upon the care we offer. This group has looked at illness beliefs in heart failure patients and found that many patients have misconceptions about the condition. Patients with low mood can lack understanding of their condition and this often leads to lower self-care confidence. We have also qualitatively explored patients views on using technology as a method of delivering healthcare and found that patients generally find the technology easy to use and it can help to empower patients to self-care and educate them about heart failure.
Our group has found that patients who see a heart failure nurse specialist have higher satisfaction in medical treatment. Patients find the support and input they receive from their local heart failure nurse extremely helpful. Wehave collected some feedback on patients’ experience of taking part in heart failure research which we hope to publish soon.
This study is examining the efficacy of a new drug in heart failure. Vericiguat (MK-1242) is a new drug that works in a different way to current heart failure treatment. Vericiguat (MK-1242) is a type of drug called a “soluble guanylate cyclase (sGC) stimulator”. Soluble guanylate cyclase (sGC) is an important enzyme in the heart and blood vessels, and reduced activity of sGC is believed to play an important role in the progression of heart failure. Vericiguat increases the activity of sGC and this may lead to improvements in heart function in patients with heart failure.
This study is looking at a novel new drug called Omecamtiv in heart failure patients which it is hoped will improve contractility of the heart muscle. The study is being carried out internationally in 8000 patients.