Research
Atrial fibrillation: stroke and bleeding risk
An integral part of my research, in collaboration with clinical colleagues, has been the development and validation of stroke and bleeding risk clinical prediction tools, the CHA2DS2-VASc score and HAS-BLED score, respectively, which are internationally recognised as being innovative and have been incorporated into most major international guidelines (e.g., NICE, European Society of Cardiology, Canadian College of Cardiology, Asia Pacific Heart Rhythm Society) on the management of atrial fibrillation (AF). This has had a significant impact on clinical practice, towards identifying very low risk AF patients who may not require antithrombotic therapy, while for everyone else oral anticoagulation therapy is considered. The validation of these risk schemas in AF cohorts has also led to several national and international collaborations and high-quality peer-reviewed publications in prominent journals, providing a significant contribution to the scientific literature. The importance of this research programme on clinical practice has also been acknowledged by a number of prestigious awards and as an Impact Case in the Research Excellence Framework (REF) 2014 (http://impact.ref.ac.uk/CaseStudies/CaseStudy.aspx?Id=38790). This work is currently being extended beyond risk stratification to implementation of guideline-adherent AF management and integrated AF care utilising the ABC (Atrial Fibrillation Better Care) pathway.
Patient-centred care
One of my major research interests is the patient and how they adapt to cardiovascular disease(s). Patient perceptions and understanding of disease and its treatment, and identification of patient barriers/facilitators to treatment are fundamental to their acceptance and adherence to therapy, which is particularly important in chronic treatments which also require lifestyle modification and adaptation. My primary research focus over the last 12 years has been atrial fibrillation but I am also interested in other cardiovascular diseases/conditions, such as heart failure, myocardial infarction/acute coronary syndrome, diabetes mellitus, and congenital heart disease. My research has employed both quantitative and qualitative methodology to explore the patient experience of AF and treatment, predominantly oral anticoagulation.
My group developed patient educational tools and a behavioural intervention (based on psychological theory) in conjunction with patient involvement; testing in a randomised controlled trial demonstrated that the intervention significantly improved anticoagulation control (evidenced by time in therapeutic range), and improved patients’ knowledge and perceptions of AF. This intervention has been culturally-adapted in two countries and is currently undergoing testing in randomised controlled trials to help improve anticoagulation control among patients taking warfarin. Qualitative research has examined the patients’ experience of AF and OAC therapy, and physicians’ attitudes to AF and OAC prescription to gain a deeper understanding and insight into the condition and its' management and to improve patient education and healthcare professional education/training. On-going research is examining a high-risk population of AF patients who have experienced an intracerebral haemorrhage ('bleed on the brain') and who require anticoagulation. I am also interested in psychological adaptation to atrial fibrillation as anxiety and/or depression are prevalent. I am currently conducting a randomised controlled trial comparing cognitive-behavioural therapy to usual care in atrial fibrillation patients who are anxious and/or depressed to improve psychological distress and quality of life.
I am also a co-investigator on a British Heart Foundation (BHF) funded project (LEADER), to develop a new patient-reported outcome measure (PROM) for patients with a left ventricular assist device, in collaboration with colleagues in Birmingham.
Global atrial fibrillation care
I am a co-investigator on a number of international collaborations to improve atrial fibrillation care for patients:
National Institute of Health Research (NIHR) funded
Global Atrial Fibrillation - Partner countries Brazil, China, Sri Lanka and UK Global AF Reach
Medical Research Council (MRC) Newton Fund
TREATS-AF - Partner countries Thailand and UK
European Union Horizon 2020 funded
PREvention of STroke in Intracerebral hemorrhaGE survivors with Atrial Fibrillation (PRESTIGE-AF) - Partner countries Austria, Germany, Spain, Italy, Denmark, France and UK PRESTIGE-AF
Research groups
Research grants
Patient preferences for the delivery of the non-alcoholic fatty liver disease clinical pathway: let’s move towards patient-centered care (NAFLD)
THE ACADEMY OF MEDICAL SCIENCES (UK)
April 2023 - November 2024
Innovation to Detect Atrial Fibrillation and optimise management in ‘hard-to-reach’ communities (iDETECT‐AF)
PFIZER LTD (UK)
September 2021 - February 2024
Quality Improvement of Stroke Care for People in Liverpool
BRISTOL-MYERS SQUIBB (USA)
October 2021 - May 2024