Clinical aspects of advanced heart disease ranging from epidemiology, through pathophysiology to clinical trials designed to improve patients' symptoms and well-being and to prolong their survival.
Since 1999 an international reference centre for the management of heart failure has been established in Kingston upon Hull, placing it in the top 10-20 clinical research centres for advanced heart disease in the world. It is the largest clinical programme for heart failure in Britain. The programme allows the development of new techniques for earlier and more accurate diagnosis, better risk assessment and for delivering the highest quality modern therapy. The programme also examines the costs of delivering quality care to determine how limited resources can deliver the most benefit for patients now and in the future.
The Daisy (Building) Heart Research Team comprising doctors, nurses and scientists have made some outstanding discoveries that are now saving millions of lives around the world. Heart failure is a serious condition that will affect one in five of the population, is one of the most common medical reasons for admission to hospital and one of the leading causes of death in Britain today. It is a sadly neglected topic with only a handful of expert heart failure research centres in England. The Daisy Team hopes to prevent it from developing, spot it early when it does develop, cure it when possible and help people who cannot be cured by relieving their symptoms and prolonging active life.
The most important recent success was developing a new type of pacemaker that can help about one in five people who have had major heart damage from heart attacks or other muscle disease (cardiomyopathy). By placing an extra electrical lead in the heart, the strength of the heart can be improved substantially in many patients and, for some, even appears to cure their heart failure. The pacemaker not only improves heart function but also improves symptoms of breathlessness and reduces the risk of dying, either of heart failure or dying suddenly. The benefits are large- much larger than for most operations or procedures. The study conducted in Hull is thought by many to be the finest piece of research in this area world-wide.
Castle Hill Hospital was also the first place in Britain for a new key-hole heart procedure to repair leaking heart valves that can cause heart failure. This has dramatically changed the lives of another group of heart patients.
The Daisy Building is also the focus for research into telehealth, another area in which Hull is a world-leading academic centre, providing one of the first operational telehealth services in the world. Telehealth allows people to make vital measurements of heart function in their own home. The information is then transmitted directly to the hospital (and in the future the patient's GP) where a nurse or doctor can advise on the need to change diet or treatment. New systems are being developed that will allow patients to look after themselves, rather than always being dependent on a nurse or a doctor for advice. This has a huge potential to improve people’s health by making sure that their medical treatment is tailored much better to their particular needs (medicine tends to be a one-size-fits-all at the moment). Research led from Hull has shown that that this type of monitoring makes sure that patients with serious heart problems, such as heart failure, are better treated, reduces the amount of time they spend in hospital and reduces substantially the risk of dying. It is hoped that in the coming decades, most people will have these sorts of systems in their homes to help manage a whole range of conditions including high blood pressure, palpitations, heart rhythm disorders, diabetes, kidney disease and lung disease.
The Daisy Building Heart Research Team are also leaders in the development of new risk markers for heart disease. One of these, called NT-proBNP, is now being offered routinely by GPs, to identify patients with breathlessness or who have had previous heart attacks, in order to identify people with seriously weakened hearts. The team has identified an exciting range of new markers for heart disease and, more importantly, new ways of analysing the information. These are set to transform how we use medicines and operations to help people. Hull has also led the way in developing new ways to image the heart. Hull led a large national study that showed, for the first time, that the damage done to some hearts by a heart attack was not permanent, that the heart muscle was only sleeping and could be ‘woken up’ by a medicine called carvedilol (a beta-blocker). In collaboration with The National Heart Centre in London, we are also running a major research study in magnetic resonance imaging (MRI) and the heart involving more than 1,000 patients.
The Team was also recently awarded a large grant to conduct a study comparing the benefits of two agents designed to reduce the stickiness of the blood (aspirin and clopidogrel). Aspirin is used most widely but there is a possibility that clopidogrel may be much better for patients with heart failure. This could improve the lives of patients and reduce costs to the NHS. Several other large grants have been awarded to look at how heart failure affects patients' lives and how to manage it better, including, for some of the most severe patients, home oxygen therapy.
Now the team is working on new treatments, including a new class of medicines called AGE-breakers – that are designed to improve the stiffness of blood vessels and the heart. Projects on Viagra (yes it may be good for your heart), testosterone, foxglove (digoxin) as well as newer agents that may improve the heart’s metabolism are being conducted.
Soon we will appoint new senior research staff to look into treatment of heart artery disease using key-hole procedures like angioplasty. Hopefully, this will allow us to develop other methods of treating severe valve disease either without the need for surgery or by much smaller operations in collaboration with a heart surgeon. We are not only interested in medical and surgical research but also nurse-led research. These new appointments will create a team of more than 40 people researching into heart disease with an international reputation for excellence that also helps provide a superb service to the local population.
All-in-all the Daisy Building has got off to a flying start. This could not have been done without the generosity of all those that made a donation for the world-class facility that we now work in. We should not forget the generosity of all those people and patients who have helped us and their fellow human beings by donating their time and their illness to the research that we have done.
Page last updated by Gillie Porter on 10/21/2010