NICOR newsletter July 2023 edition
Welcome to NICOR’s July newsletter. As we approach the summer months, we have a lot to be proud of in the first quarter of…Read More
CHAMPION is a research study funded by the National Institute for Health Research. The principal investigators are Dr Sonya Crowe and Professor Christina Pagel, and the study sponsor is University College London (UCL). The study aims to improve how the quality of services for congenital heart disease (CHD) is measured and reported.
No new data will be collected as part of the study: the research will use data already collected routinely across England and Wales. Most of the data being used for CHAMPION is already held at a secure location at University College London for use in another study (called LAUNCHES) that is also being led by Dr Sonya Crowe and Professor Christina Pagel:
Summary: This research will encompass a population-based, patient-level analysis of heart failure in England over a 5-year period using a dataset created by linking the HES and NICOR databases. Analyses will look into the re-occurrence of hospitalisation after the initial diagnosis of heart failure, the influence of population factors on risk of re-hospitalisation and the resultant cost implications.
Summary: Heart disease and cancer are the commonest causes of death in the UK. Treatments are leading to better outcomes which means people are living longer with these conditions. This means more people are living with both conditions. These conditions interact on many levels and yet there is little current research focused on these interactions. The Virtual Cardio-Oncology Research Initiative
(VICORI) is a collaborative programme funded by the British Heart Foundation (BHF) and Cancer Research UK (CRUK) to investigate, using data collected as part of national audits, the interaction between heart disease and cancer.
Summary: When someone has a suspected heart attack the ambulance service are equipped to perform a heart tracing to determine whether they need to take the patient to a specialist hospital department. Our previous research showed that patients who had this test – pre hospital electrocardiogram, or PHECG – had a better chance of survival. But a third of patients who should have didn’t receive the test. Our previous research took place at the time when the main treatment for heart attack was ‘clot busting’ drugs. Treatment has since changed and is now mainly with balloons and stents. We don’t know if the PHECG is still associated with benefit in the modern era and want to look at data from a large national heart attack audit (Myocardial Ischaemia National Audit project or MINAP) to assess this. We also want to understand more about how ambulance staff decide to perform the PHECG test, so plan to look at ambulance records and hold focus group discussions with ambulance staff. Using these different types of research methods we hope to be able to learn about barriers and facilitators to the use of the PHECG test so more patients benefit and have better outcomes following their heart attack.
Summary: LAUNCHES QI is a research study which is funded by the charity the Health Foundation. The chief investigators are Professor Christina Pagel and Dr Sonya Crowe, and the study sponsor is University College London (UCL). The research study is not collecting any new data as part of the study, but using data already collected routinely across England and Wales, to understand better the quality of services that the NHS provides to people born with Congenital Heart Disease. The National Congenital Heart Disease Audit (NHCDA) has collected information on every heart procedure performed on children and adults with congenital heart disease in the UK since 2000. The project will use this data from English and Welsh hospitals to understand better what happened to patients in the NCHDA database (of any nationality), by looking for data on these patients that appear in four other national, routinely collected, datasets. Services for congenital heart disease span a patient’s lifetime, but at the moment their quality is mainly measured by 30-day survival following children’s heart surgery – the project aims to create a more comprehensive and meaningful picture of services so that both services and information available to patients and their families can be continually improved.
Summary: The Long term outcome by cardiac diagnosis (LTO) project is a research study. It is funded by the British Heart Foundation (BHF Project Grant no. PG/17/88/33401). The Chief Investigator is Dr Katherine Brown and the study sponsor is University College London (UCL).
We will use the information that has been collected each time a child had a heart operation in England and Wales between 2000 and 2018, to work out how many children born with more complex heart defects survive longer term. Data are always collected as part of a quality check process when children have surgery, but up until now have only been used to assess short term mortality rates. We will work out the proportion of children with more complicated heart defects that survive until primary and secondary school ages as well as the proportion of children who have additional operations that were not planned as part of their expected treatment during childhood. We will find out whether children who are less well off or are from certain ethnic minority communities do worse than others. We will find out whether getting a defect diagnosed before birth or whether being treated at a hospital that cares for larger numbers of similar types of patient helps children do better.
On 10 September 2020 NICOR published a report into the impact of the COVID-19 pandemic on cardiac healthcare. You can read this here. The analysis has also been published in various journals. Two of the researchers, Professor Chris Gale at the University of Leeds, and Professor Mamas Mamas at Keele University, have produced videos looking at the findings of the NICOR report. View these below:
This study is designed to study the incidence of post discharge complications, readmissions and their association with long term outcomes of patient suffering from heart attack in England and Wales. We are looking into the relationship between different complications such as bleeding, repeat heart attack within 30 days of first heart attack, unplanned readmissions and long term survival of patients with heart attacks. This is particularly important as heart attack remains one of the commonest cause of death in the UK and worldwide. This will enable us to understand better the efficacy and safety of newer treatments of heart attack patients, describe patterns of different complications and how they impact on the patient’s outcomes. Using this information, we wish to develop prediction models to predict future heart attacks and complications. This will also enable us to optimise the treatment pathways of heart attack patients locally and nationally.
For this study we will first identify all patients who were admitted with heart attack in England and Wales and participated in Myocardial Ischaemia National Audit Project (MINAP). This is one the world’s largest database of patients admitted with heart attacks in a universal healthcare system and the data is hosted by the National Institute for Cardiovascular Outcomes Research (NICOR). MINAP is part of the National Cardiac Audit Programme (NCAP), which brings together six major cardiovascular domains into one national clinical audit for which the Healthcare Quality Improvement Partnership (HQIP) are the data controller. The Hospital Episode Statistics (HES) dataset which stores data on all admissions, outpatient appointments and A&E attendances in England will be used to capture information about post discharge complications and readmissions of all heart attack patients registered in the MINAP. It also includes data on diagnoses, patient information and medical procedures. This is data is managed by NHS Digital, Leeds. The information about the death status of the patients will be obtained from the Civil Registration and Death Register in England and Wales.
By combining these three datasets, we will be able to study the incidence and impact of complications and characteristics associated with an increased risk of being readmitted to hospital for heart attack.