Associate Feature: Embedding research in practice

Scotland continues to have high rates of death and disability due to cardiovascular disease (CVD) despite improvements in disease management.

Even during the Covid-19 pandemic, CVD has remained the leading cause of poor health in Scotland. The new heart disease action plan, launched in April 2021 highlights the need to act across four key priorities:

1) Prevention by addressing risk factors for CVD 

2) Timely and equitable access to diagnosis, treatment and care

3) Workforce development

4)Effective use of data

To ensure these priorities are met, it is essential to match research priorities with the heart disease action plan.

Clinically research-active hospitals have better patient care outcomes. During Covid-19 the importance of clinical research has been widely demonstrated, with trials of a scale and speed not previously seen.

The usual timeline for research evidence to make its way into clinical practice is around 15 years. This means many effective treatments may not be available for many years.

It is likely that a focus on a common goal improved the dissemination of Covid-19 trials and therefore greatly reduced the time to make vaccines available. These lessons should inform all future clinical trials to improve health outcomes globally. 

There are additional considerations to improve uptake of clinical trials in Scotland. During Covid-19, delays occurred in cardiac care, including reduced presentation at hospital, a 67 per cent reduction in echocardiogram referrals, a 150 fold increase in people waiting over a year from cardiac surgery, and more that 5500 excess CVD deaths.

This has created a significant backlog of people needing investigation and treatment. It is essential that clinical trials are given equal priority to ensure that people with, or at risk of CVD, are given access to new treatments that can only be developed through the work of our researchers.  

The National Health Service Research Scotland CVD network currently has around 150 CVD clinical trial study sites, second in scale only to cancer clinical trials in Scotland. To continue to drive delivery of high quality CVD in research in Scotland, we will focus on addressing inequalities in Scotland and ensure purposeful inclusion of minority groups.

We also recognise that historically CVD research has not included as many women as men, and that we need to prioritise gender balance in our studies. To act on improved diagnosis and treatment we need to develop trials of precision medicine and genomics, and we need to ensure that we evaluate the effective use of clinical pathways, underpinned by realistic medicine principles. 

We also need to support a research culture at work by retaining the cooperation that saw such successful outcomes on Covid-19 research. This means investing in interdisciplinary researchers and creating opportunities for clinical academic careers.

Ensuring that positions involve protected time for research will be part of the solution, but we know that barriers such as complex ethics and governance procedures can detract individuals from undertaking research and solutions, and a focus on streamlining these processes could improve interest in leading research. 

Finally, it is essential that our research priorities are patient-centred. Creating a research positive culture can overcome the barriers of patients accessing clinical trials. A recent systematic review concluded that patient and public involvement (PPI) with clinical trials is likely to increase recruitment and retention to studies and thus we need to prioritise PPI to increase the success of CVD research in Scotland and to improve the lives of people living with CVD. 

Professor Lis Neubeck is head of the Centre for Cardiovascular at Health Edinburgh Napier University and NHS Research Scotland Cardiovascular Disease Network clinical lead.

This article was sponsored by the British Heart Foundation