Heart disease research should be “part and parcel” of clinical work, says top clinician

Golden Jubilee Hospital - credit NHS Golden Jubilee National Hospital

Cardiovascular disease (CVD) is a leading cause of illness and premature death in Scotland across all ages and genders. It has been a clinical priority for the NHS for decades, with increased investment in cardiology services across the country. This has led to an increase in survival rates for patients with heart attacks and heart failure and a reduction in the overall mortality between 2005 and 2014.

However, Scotland still has higher death rates from CVD per head of population than anywhere else in the United Kingdom. According to the British Heart Foundation, five of the ten regions with the highest CVD incidence are in Scotland, with Glasgow listed as the worst in 2011/12.

Comparing figures for an in-hospital diagnosis of CVD, Scotland is again higher than the UK average (12.1 per cent vs 8.4 per cent for men and 10.0 per cent vs 6.2 per cent for women).

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CVD is age-related and so, with an ageing population, the burden on the NHS will inevitably continue to increase.

Limitations on available resources and a drive towards personalised care (stratified medicine) to ensure the best possible outcome for every patient mean that new therapeutic strategies and ways of providing care must be found. Evidence-based clinical research is a mandatory prerequisite to developing these new treatments and care pathways and requires a major investment of time and energy on the part of both the investigators and their patients. 

Fortunately, Scotland has risen to this challenge. Currently, there are approximately 150 ongoing cardiovascular clinical studies with over 16,500 participants across the country. In terms of scale, this is second only to cancer research. Over one third of these studies are led by researchers based in Scotland, predominantly from the four major university schools of clinical medicine (Aberdeen, Dundee, Edinburgh and Glasgow).

NHS Research Scotland (NRS), which is based in the Golden Jubilee National Hospital, also directly supports a broad range of commercial and non-commercial research activity via a number of designated networks and specialty groups tasked with improving recruitment into important practice changing clinical trials across the country.

Examples of such trials include SCOT-HEART, which showed the value of using CT scanning to image the heart arteries in patients with suspected angina, PRAMI, which confirmed the value of placing stents in all narrowed heart arteries rather than just the artery causing the immediate problem in patients presenting with heart attacks, and PARADIGM-HF which demonstrated dramatically better outcomes with a new drug for the treatment of heart failure.

The funding to support this research activity comes from a variety of sources including commercial entities such as pharmaceutical and medical device companies, governmental agencies such as the Chief Scientist Office of the Scottish Government Health Department, the Medical Research Council and the National Institute of Health Research (UK-wide) and charitable organisations such as the Wellcome Trust, British Heart Foundation, Heart Research UK and Chest, Heart and Stroke Scotland.

Beyond this, the European Union has and continues to provide very substantial support for biomedical research through the FP7 programme, which was recently renewed as Horizons 2020. It remains to be seen if Brexit (in whatever form) will prevent UK-based groups accessing these funds. There are similar concerns about Scottish groups accessing UK funds in the event of future Scottish independence.

One of the main growth areas for clinical research in Scotland, across all sub-specialties of medicine, are the large district general hospitals where research activity is substantially less than in the major university teaching hospitals.

These hospitals are full of consultants with prior research experience as junior doctors, many with higher research degrees, and many of whom remain enthusiastic about carrying out clinical research. They have the patient populations but, since the introduction of the new consultant contract in 2004, many of them (especially the most recent appointments) no longer have the time within their busy clinical commitments.

In order for the research potential of these hospitals to be fully realised, it will be necessary to look again at consultant contracts, and to reinstate ring-fenced time within the job plans of those able and willing to undertake this challenging but professionally rewarding work, which is critical to the future of healthcare both in Scotland and elsewhere. Research should not be an optional extra, it should be part and parcel of the daily activities of all healthcare professionals. 

Professor Keith G Oldroyd is NHS Research Scotland’s national cardiovascular champion and Dr Ewan A Dougall is his support manager. They are based at the Golden Jubilee National Hospital.