Associate Feature: The Beating Heart

When a group of medical professionals got together in 1961 to address concerns about the number of deaths from cardiovascular ailments, they had one aim in mind: to create a foundation that would fund research into the causes, diagnosis, treatment, and prevention of heart disease. Their vision resulted in the creation of the British Heart Foundation, which, sixty years on, has become a household name that is still going strong.

“Over the past 60 years the British Heart Foundation has contributed to a lot of achievements the public will be familiar with, but also some they maybe won’t connect us with,” says Professor James Leiper, the charity’s associate medical director.

“We’ve funded research that has allowed heart transplants to take place and the first clinical trials of statins were done by British Heart Foundation-funded researchers – Dr Stuart Cobb at the University of Edinburgh did one of the first trials that showed that statins save lives for people who are having strokes.

“We’ve contributed to pacemaker technology, we’ve rolled out defibrillators and we’ve campaigned to have training on the use of defibrillators. In Scotland, every school pupil gets trained in the use of those and CPR [cardiopulmonary resuscitation].

“Some researchers in Scotland have been looking at cardiovascular disease in women, which has been under-researched – if you go back 30 years it was seen as a male, middle-aged disease, but that’s not the case.

“The British Heart Foundation has made contributions right across the board of cardiovascular health.”

Despite celebrating its sixtieth anniversary year, as a charity funded entirely by the public the British Heart Foundation has suffered hugely in the past 18 months. The impact of the coronavirus pandemic saw its annual income fall from £100m to £50m in one fell swoop when lockdowns meant all 750 of its UK shops were forced to close and mass fundraising activities had to be out on ice. The impact, Leiper says, has been immense.

“Almost overnight those income-generating activities were switched off and then [the shops] became a cost,” he says. “That was massive.

“Our funding dropped by 50 per cent during the pandemic. Normally we spend £100m a year on research – we’re the biggest independent funder of cardiovascular research in the UK – but we had an instantaneous cut to the amount of money we could give to researchers. That was a massive blow.”

To insulate against the impact of that blow, the organisation took the decision to protect the research it had already invested in by extending the grants it had made available to researchers. Most grants are awarded over three or five-year timeframes, but given the disruption caused by the pandemic everyone has been offered additional time. Though it meant digging deeper when times were tough, Leiper says it was an investment worth making.

“We fund PhD students,” he says. “They are the newest, brightest people coming into cardiovascular research - they will be the professors in 20 or 30 years’ time. Just for the PhD students, extending their projects cost £1m at a time when our income had halved but it was the right thing to do because we depend on having the brightest people in the research community.”

That does not mean that cardiovascular research, which largely ground to a halt when the pandemic hit, will weather the coronavirus storm unscathed. Leiper stresses that, even with the additional resource, it is unavoidable that research that is already underway will be delayed. The knock-on impact, he says, is that patients who are already being affected by longer NHS waiting times “won’t get those new innovations as quickly and they will suffer”.

And, while he says the queues that formed outside British Heart Foundation shops when they were able to reopen have put the charity on course to recover, Leiper adds that it will take several years for funding to get back to pre-pandemic levels. That means the organisation is having to make some hard decisions about what it can finance in the near term.

It’s not good enough just to be excellent – you now have to fit into the top 10 per cent of priority to get funded. We know if we fund these projects they have an excellent chance of increasing our understanding of cardiovascular disease, but for many they will be lost

“The way we decide who’s funded is we have a panel of experts and they assess all grants,” he explains. “They always have to be excellent to be funded but we’ve now had to move the bar even higher. It’s not good enough just to be excellent – you now have to fit into the top 10 per cent of priority to get funded.

“We know if we fund these projects they have an excellent chance of increasing our understanding of cardiovascular disease, but for many they will be lost. To now have to take that group of excellent and try to prioritise among them is really tough.”

The long-term impact of that is difficult to quantify, not least because it takes time for any research project to bear fruit. Though Leiper says there are concerns about the adverse effect that could have on the practice of cardiovascular medicine, he says on the flipside there is so much excitement about the direction research could go in that the British Heart Foundation is running a competition that will see one group of researchers awarded an unprecedented £30m grant.

From an initial round of 75 proposals a shortlist of four projects has been drawn up in the Big Beat Challenge and a panel led by the UK government’s chief scientific adviser Sir Patrick Vallance will pick the ultimate winner. Given the standard of entries, Leiper says, that panel has been handed an unenviable task. 

One of the projects, which is being led by a team at the University of Amsterdam, plans to create a solution for heart failure by developing a robotic heart that could replace the need for transplantation. Another, which is based at the University of Cambridge, aims to use data to map the fatty deposits that develop in arteries and come up with targeted medicines and vaccines to prevent heart attacks and strokes.

An entry from a team led out of KU Leuven University in Belgium wants to develop advanced wearable technologies that would help revolutionise the diagnosis, monitoring and treatment of heart and circulatory diseases. The final shortlisted candidate, meanwhile, is looking to develop a treatment that would target and silence the faulty genes responsible for diseases of the heart muscle that can lead to sudden death or heart failure at an early age. That entry is being led by a team at the University of Oxford.

Having made it onto the shortlist, each of these teams has been given some seed finance to bring their proposals forward. After six months of work, one will be handed the £30m grant as well as the opportunity to revolutionise the cardiovascular research landscape.

“I’m really excited about all of them and I think it’s a fantastic competition,” Leiper says. “If you want evidence of our ambition going forward, this is it. We as funders don’t discriminate between the projects and I think they are all fantastic projects. Wouldn’t it be brilliant if we could find a way to fund them all? We don’t have the money to do that, but if governments or other foundations wanted to join us to fund them that would be a brilliant thing to do.”